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A simple guide to high-deductible health plans

Wondering if a high-deductible health plan (HDHP) is right for you? We’re here to answer your questions to help make your health care journey easier.

What is an HDHP and how does it work?

 

An HDHP has a higher deductible than a typical health plan. That means you pay out of pocket for your medical expenses until you reach a certain amount. Then, your plan begins to pay.

 

Savings tip: An HDHP has a lower premium. That means you pay less every month for your plan. HDHPs also cover many preventive services and screenings at no cost without having to meet your deductible.

 

How it works

You pay

Your plan pays

First, you pay all your medical costs
When the plan year begins, you pay the full cost of your care until you reach a fixed dollar amount. (This is your deductible.)

100%

0%

Next, you and your plan share medical costs
After you meet your deductible, you pay a smaller portion of your medical costs. (This is your coinsurance.) Your plan pays the rest.

Then, your plan pays for all of your covered medical costs
Once you meet your out-of-pocket maximum (this is your deductible plus coinsurance limit), your plan pays for all covered medical services in full.

0%

100%

How it works

First, you pay all your medical costs
When the plan year begins, you pay the full cost of your care until you reach a fixed dollar amount. (This is your deductible.)

You pay

100%

Your plan pays

0%

How it works

Next, you and your plan share medical costs
After you meet your deductible, you pay a smaller portion of your medical costs. (This is your coinsurance.) Your plan pays the rest.

You pay

Your plan pays

How it works

Then, your plan pays for all of your covered medical costs
Once you meet your out-of-pocket maximum (this is your deductible plus coinsurance limit), your plan pays for all covered medical services in full.

You pay

0%

Your plan pays

100%
 

Everyone’s health needs are different Is an HDHP right for you? We’ll help you decide.

Top 5 advantages of HDHPs

 

An HDHP may make sense for you if you’re rarely sick or injured and can afford higher upfront costs if the unexpected happens. Benefits include:

 

Lower monthly premiums

You can feel good knowing you're paying less for monthly coverage.

 

Lower medical expenses

If you rarely need to see a doctor or use your benefits, you may spend less on your health care.

 

Quality care for less

You get special discounts when you choose providers in our network. Our plans include a broad network of providers.

 

An account to help you save on health expenses

An HDHP is the only plan that can be paired with a health savings account (HSA). An HSA helps you save pretax money for health expenses like deductibles and coinsurance. Even prescriptions, dental care and eyewear.

 

Savings for the future

When you add money to your HSA, you lower your taxable income. Your earnings are tax-free. And your HSA is always yours, even if you leave the plan.

Top things to consider about HDHPs

 

An HDHP may not make sense for everyone. You’ll want to think about your lifestyle and health needs. For instance, if you have young kids, get ongoing treatment for a condition or take several medicines, your upfront costs may be higher. Other things to keep in mind:

 

These plans have higher deductibles.

That means you pay for doctor visits, tests and prescriptions until you meet your deductible, then your plan begins to pay. If you have an individual plan, the minimum deductible is $1,700. If you have a family plan, the minimum deductible is $3,400. Minimum deductible details.*

 

 

Medical emergencies can happen.

Even if you’re fairly healthy, health needs and emergencies can pop up. Are you prepared to pay your full deductible up front?

 

You may be tempted to put off important care.

Some people might skip a trip to their doctor or the emergency room because of the upfront cost. The good news is that a health savings account can help you cover these costs.

 

Other plans may be available to you

Want to explore more plan options? Learn the differences between HMO, PPO and POS plans to help you choose.

 

High-deductible health plan FAQsThink insurance is confusing? We’re here to help.

  • Most people change their plans during open enrollment. This is a period that happens once a year when you can sign up for insurance. You can also adjust or cancel your plan.

     

    Have a big life change or one coming up? Certain events, like getting married or losing your coverage, qualify you for a Special Enrollment Period. That means you can enroll in a plan or change your plan outside open enrollment.

  • If a service is covered, that means your health plan will pay for some or all the cost. With an HDHP, you’re covered for medical services after you meet your plan deductible.

     

    Covered services include:

     

    • Doctor visits
    • Emergency care
    • Hospital stays
    • Prescription drugs and more

  • HDHPs often cover in-network preventive care in full without having to meet your deductible. This benefit can help you save. That’s because preventive care can help prevent or find health issues before they become more costly.

     

    Examples of preventive care include:

     

    • Blood pressure, diabetes and cholesterol tests
    • Routine prenatal and well-child care
    • Flu shots and other routine vaccines
    • Cancer screenings, such as mammograms and colonoscopies
    • Screenings for heart disease, infectious disease, mental health conditions, obstetric and gynecological conditions, and more

    Keep in mind: Preventive care does not include services to treat an illness, injury or condition.

  • Choosing network providers can save you money. Here’s why: The providers in our network have agreed to special, contracted rates. That makes it less costly for you.

     

    Things to keep in mind: 

     

    • Some plans include out-of-network coverage. But providers who aren’t in our network are not contracted with us and may charge higher rates.
    • Your out-of-network deductible is separate from your in-network deductible. So even if you’ve met your in-network deductible, you’re still responsible for the cost of any out-of-network care.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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