High Deductible Health Plan

Health insurance is a proposition of pay now or pay later. With HMO coverage you pay higher monthly premiums with little or no copayments when you vicsit your doctor. The other end of the spectrum is the high deductible PPO policies where you pay lower monthly premiums but pay larger amounts of money when you visit your doctor. Keep in mind the carrier plans vary but as an example, if you broke your arm and were on an HMO you would pay a copay and very little out of pocket for treatment. If you are in a high deductible plan you are going to pay for the cost of the X-ray, consultation, and casting of your arm until you reach your deductible. The HMO visit might cost you a total of $40 and the High deductible plan visit might cost you $2000. It seems like a no brainer as to which plan you should be on until you calculate the premium payments.

HMO = $1000 per month with minimal copays and coinsurance.

Total out of pocket for the year ~$15,000.

High deductible PPO = $500 per month with a $7500 deductible.

Total out of pocket for the year ~$13,500.

What if I didn’t go to the doctor at all that year? I have spent $15,000 on the HMO (no refund for not going) and I spent $6000 on the high deductible PPO.

What is I do go to the doctor for something significant? I have spent $15000 on the HMO and $13,500 for the high deductible PPO.

Please keep in mind that the high deductible plans have reasonable (~$40) to no copays for annual checkups and preventative visits. This includes immunizations and child well being annual checkups. The other incentive is the HSA (Health Savings Account) qualified high deductible PPO plans. This gives you the option/incentive to use tax deductible dollars to pay your high deductible.

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