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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 and help make your health care journey a little easier.

What is an HDHP, and how does it work?

 

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

 

Savings tip: HDHPs have lower premiums. That means you pay less every month for your plan. Plus, you’re covered for 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

We’ll help you decide if an HDHP is right for you

 

Top 5 advantages of HDHPs

 

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

 
Lower monthly premiums

You can have peace of mind 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 monthly insurance payment.

Quality care for less

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

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 pre-tax 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 consider your lifestyle and health needs. For instance, if you have young kids, get ongoing treatment for a condition or take several medications, your upfront costs may be higher. Here are 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 and your plan begins to pay. If you have an individual plan, the minimum deductible* is $1,500. If you have a family plan, the minimum deductible is $3,000.

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 ER 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 other coverage options? We’ll explain the differences between HMO, PPO, and POS plans to help you choose.

 

High deductible health plan FAQs

Think 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 typically cover in-network preventive care in full without having to meet your deductible. This benefit can help you save. That’s because it 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, including mammograms and colonoscopies
  • Screening services for heart disease, infectious disease, mental health conditions, obstetric and gynecological conditions, and more

Note: Preventive care does not include services to treat an existing illness, injury, or condition.

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

 

Some plans include out-of-network coverage. Just keep in mind that providers who are not in our network are not contracted with us. And they may charge higher rates. Another thing to consider is that your out-of-network deductible is separate from your in-network deductible. So even if you’ve met your in-network deductible, you would still be 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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