Understanding High Deductible Health Plans

by The Juno Team
Understanding High Deductible Health Plans

High Deductible Health Plans (HDHP) are part of a growing trend toward consumer-driven health care. These types of plans, which feature a lower monthly premium and a higher deductible, are about enabling people to have more control over their health care finances. Most large employers and health insurance exchanges will offer an HDHP. There are key differences between HDHPs and plans that feature co-pays or co-insurance — so read on to find out the most important details you need to know.

What's a high deductible health plan (HDHP)?

HDHPs have lower premiums than traditional health plans that feature co-pay or co-insurance. The trade-off is that these plans also have a higher deductible — the fixed dollar amount you must pay out-of-pocket before your plan begins covering your care. Your coverage starts once you “meet” your deductible. This means that your out-of-pocket costs will typically be higher than with a traditional plan. Even in a high deductible plan, there are ways for you to control how much you spend on care.

What will I have to pay for care?

Before you meet your deductible you are responsible for paying your insurance carrier’s negotiated cost for office visits, prescription drugs, and other services. Under the Affordable Care Act, many plans including HDHPs will cover preventive services like annual physicals, cancer screenings, and routine immunizations before you meet your deductible and without having to pay a co-pay or co-insurance. Keep in mind that this applies to services provided by in-network providers. After you meet your deductible, you will still have to pay co-pays for prescription drugs until you reach the out-of-pocket limit. Your health insurance plan may have separate deductibles for different types of services, like in-network and out-of-network care. Also, your plan may have different deductibles for single and family coverage — so be sure to know the details.

How do I pay for care?

If you select an HDHP, you are also generally able to set up a health savings account (HSA) to help pay for eligible medical expenses. These plans let you or your employer put aside pre-tax money to offset your deductible. If you still have money in your account after you meet your deductible, you may use it for co-pays, co-insurance, other types of costs, or you may save it from year to year. Most doctors will accept payments for services via your HSA account — that said, it's a good idea to confirm before you schedule your appointment.

How will I know when I meet my deductible?

When you visit your doctor or have a procedure, your provider submits a claim to your health plan if they are in-network. Your health insurance carrier will track the cost of the service and apply eligible costs to your deductible. To find out what your plan considers to be an eligible cost, read through your plan documents or contact your health insurance carrier with any questions. The explanation of benefits (EOB) form that your health insurance plan sends after you receive a service from a provider will show whether you have met your deductible or not. If you are still below the limit, your EOB will say that the plan has not paid for the service and you will need to pay the full cost. If you have met your deductible, your EOB will show how much your plan paid, according to its rules. You can also visit your health insurance plan's website to see how close you are to meeting your deductible. It’s a smart idea to keep track on your end, too. Be sure to keep a record and copy of all your healthcare receipts and claims, along with how much should be applied to your deductible.

Things to know before your appointment

If you haven’t met your deductible, it’s a good idea to know how much your service will cost before you visit the doctor. You can also ask your doctor directly how much a procedure or service will cost. If you stay in your plan’s network, your doctor will usually charge your plan’s in-network “contracted rate” even if you are paying the whole amount out-of-pocket because you have not yet met your deductible. If you go out-of-network, the cost will usually be higher than the in-network contracted rate and you will be balance billed.

We've got you covered with transparent prices

At Juno, we know that understanding health insurance and payments is hard — so we're committed to making both a lot easier for you. We believe in being open about the prices of our treatments and services so you can know what to expect and make informed decisions. Having an HDHP can feel daunting, but we've got you covered with affordable prices that won't break the bank and the ability to pay at the time of service.

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