A High-Deductible Health Plan (HDHP) is a plan with a higher deductible than a traditional health insurance plan. The monthly premium is usually lower, but you pay more healthcare costs yourself before the insurance company starts to pay its share.
Planning a procedure on an HDHP can be very affordable because you can use funds from your Health Savings Account (HSA). This type of account is unique to HDHPs and allows you to pay for certain medical expenses with money that has not been taxed by the federal government. You are eligible to reserve $3,450 annually (pre-tax) for an individual and $6,850 (pre-tax) for a family to pay for qualified medical expenses, including your deductible.
Factors to Consider When Planning a Healthcare Procedure on a HDHP
There are several pieces of information that you must obtain before scheduling your procedure. An HDHP allows you to direct your own healthcare, and this begins with careful planning. Three important considerations are the cost of your procedure, the quality ratings of your provider and the timing of your procedure.
The Cost of Your Procedure
Because you are responsible for costs for covered healthcare services until you reach your deductible, you should comparison shop if you elect to have a non-emergency procedure. Many health insurance websites provide information on where to find in-network services. Some even offer cost-estimator tools that give the price you would pay to various providers for a specific service. One of the benefits of an HDHP is that out-of-pocket expenses are the negotiated rate between the healthcare provider and insurance company, not the market rate. This can bring significant savings.
To obtain accurate pricing, ask your physician’s billing office for the Current Procedure Terminology (CPT) code for your procedure. You will want to call your insurance company for detailed information about your out-of-pocket responsibility.
Remember that many preventive tests and screenings are covered at 100 percent. You may be able to find a list of covered preventive procedures on your health insurance provider’s website, but call Member Services to confirm before scheduling.
The Quality Ratings of Your Provider
Quality can vary just as much as price, so do your research to find independent ratings of physicians and facilities you are considering. Be open with doctors about your goals of balancing cost with quality of care. Often, doctors may offer solutions for less expensive tests, services, procedures or prescriptions. This may help you in your final decisions.
The Timing of Your Procedure
Timing is also an important consideration. If you anticipate needing an expensive procedure that approaches or exceeds your deductible, schedule it early in the year, if possible. After you have met your deductible, your plan will pay for 100 percent of covered services for the rest of the year. This is where HDHPs can work in your favor, so plan expensive procedures carefully.
Questions to Ask Your Insurance Provider to Determine Procedure Costs on an HDHP
To begin using your healthcare dollars more efficiently under your HDHP, refer to this guide the next time you schedule a procedure: