In my opinion, high deductible health plans are one of the best options available to small businesses and individuals looking to save some premium dollars. They certainly aren’t perfect though so I will give you a an idea of what to expect before you take the plunge.
I have personally been covered by a high deductible health plan for the past three years. I have probably saved over $10,000 in premiums over those three years compared to having a premium plan option. Of the $10,000 I’ve saved, I have had about $6,000 in claims so I am still way ahead of the game. Knock on wood!
First off, what is a high deductible health plan?
For the purposes of this post, we are assuming it is a HSA qualified plan, so it will have a minimum single deductible of $1,200 and a minimum family deductible of $2,400.
These plans also have no first dollar coverage so you pay for all services, except for preventive care until you meet your deductible. After the deductible is met, you then pay according to the plan. It may be a fixed copayment for services, a cost sharing or a combination of the two.
On With The Disadvantages
- Premium Savings – Before you go all in with an HSA/high deductible plan, you need to evaluate how much you are saving in premium for how much you are going to risk. If your particular plan has a $2,500 deductible and it is only $500 cheaper than a much better plan, it may not be a good buy. Your broker should be able to help with this analysis.
- Upfront claims exposure – you do your homework and the HSA is the way to go with savings of $200 per month and a $2500 deductible. Sounds great right? Maybe not. If you have a large claim in the first month, you will have to pay for that service right away before you have had a chance to save the money. You may be able to get a payment plan from the hospital or provider, but it does provide another potential issue.
- Claims Paperwork – you will be self administering a lot of your claims, so you must do your due diligence to make sure all claims are paid correctly and on time. With an HSA, your provider will bill the insurance carrier and then you pay based on the approved amounts.
- Receipts – the IRS requires that you save all receipts in case you ever need to substantiate a purchase. Good bookkeeping is a must!
- Short plan years – this goes along with the upfront claims exposure. Most health insurance plans have a calendar year deductible, so the first year can be tricky. If your plan has a $2500 deductible and starts in November, you could potentially pay out $2500 in December and then another $2500 in January.
Those are the main disadvantages that I have come across personally since I have had my HSA. As long as the premium savings are there, most of the issues aren’t that big of an issue and you just have be able to do proper bookkeeping. Once you get the hang of it, these plans are no more work than anything else.
If you can think of anything I may have missed, or that you have personally run into, please send me a note so I can update the list.