Are you getting the most out of your high-deductible health plan?

Robert H. Shmerling, MD

Faculty Editor, Harvard Health Publishing

Follow me on Twitter @RobShmerling

Picking a health insurance plan can be maddeningly complicated. It may seem that no matter what you do, you’re picking the wrong plan. Should you go with the one with high monthly premiums that covers just about everything and even pays for medications? Or maybe it’d be best to go with one with lower premiums but that covers fewer expenses. Picking the one that’s best depends on your medical conditions, the medications you take, and, to some degree, your ability to predict future medical expenses. And it only gets more difficult as costs rise and medical care gets more complex.

Enter the “high deductible health plan” (HDHP). While these health insurance plans have relatively low monthly premiums and cover catastrophic illness, they have high deductibles — the out-of-pocket payments charged before the insurance plan kicks in. For example, a typical HDHP might require you to pay out of pocket for health care expenses up to $1,300/year (or $2,600/year for families), in addition to your monthly premiums, before insurance covers most medical expenses.

HDHPs are often chosen by young, healthy people who don’t anticipate the need for a lot of healthcare or medications. Of course, anyone’s healthcare needs can change; a new illness or injury can make what seemed like a good choice at the time even more expensive than traditional healthcare insurance.

Do high deductible health plans lead to more cost-conscious use of healthcare?

It’s long been assumed that having to shoulder more of the financial burden for doctors’ visits or treatments would encourage people with HDHPs to become more cost-conscious and careful about their use of healthcare services. Not so, according to a new study.

Researchers surveyed more than 1,600 people enrolled in an HDHP about their use of healthcare services (such as seeing doctors or filling prescriptions) over the prior year, including efforts to plan ahead and limit their own out-of-pocket expenses.

Here’s what they found:

  • Only 40% saved in advance for healthcare expenses.
  • Just 25% talked to a healthcare provider about the cost of services.
  • Only 14% compared prices of healthcare providers or services in advance of receiving care; a similar proportion compared quality.
  • Only 6% tried to negotiate the price of healthcare services with the provider.
  • While a minority of people took these measures to lower their healthcare costs, those who did were often successful — about half of the time, they were able to get help receiving a needed service, or paid less for it.

These results suggest that people with HDHPs are not doing all they can to lower their own healthcare expenses.

Not the last word

The results of this study may not apply to everyone. The researchers “over-sampled” people with chronic conditions who have the most to gain by trying to lower their healthcare expenses; about half of the study sample had at least one chronic condition. In addition, more than 80% of the study sample was employed and had an employer-sponsored healthcare plan. Finally, this study relied on self-reported information from an internet-based survey. For people who are healthier, don’t have healthcare benefits at work, or do not have access to the internet, results could have been different.

So what?

If you have an HDHP, you may be able to cut the costs of your healthcare by taking the results of this study to heart. Not so long ago, many considered talking about the cost of healthcare with their healthcare provider taboo. Those days are long gone. And saving in advance only makes sense, since unforeseen healthcare expenses can be hefty.

While the landscape of American healthcare and payment programs continues to evolve, as long as healthcare costs are high and rising, HDHPs are likely to be a common option. And that means more financial risk than with traditional plans. So it’s important to speak up, ask questions, and recognize that when it comes to healthcare, it’s often possible to save money without sacrificing quality.

Related Information: Navigating Health Insurance


  1. Joy

    Who gets to negotiate a price when the in-network price has already been negotiated between the provider and the insurance company?

  2. Joe Weinmunson

    I swear, just READING this was bad for my health. To address the statistics in the bullet list, in order:
    * Part of the reason buy high deductible plans is because they are the cheapest; when you’re living paycheck to paycheck of COURSE you can’t save for medical expenses.
    * Doctors typically have no notion of how much patients get billed. To some extent that’s because it’s not their job–they want to recommend the best treatment, not the most cost effective one.
    * Comparing cost of healthcare providers? I live in a rural area. There are basically two neurologists I could see without driving for hours. That’s assuming you have the luxury of comparing and don’t just need care right away.
    * Trying to negotiate the price? LOL, good luck with that. I’ve been told flat out by the head of hospital billing “Look, that’s just how much it costs. We can’t change it.”

  3. Joseph D Matthews

    Deductibles are out of control but the real problem, which is rarely addressed, is cost (what you get charged). Our diagnostic ultrasound prices are already close to 75% of our hospital competitors. In addition, our ultrasound company in California takes 20% off our prices for cash pay patients who don’t want to use or don’t have insurance. Patients should always call and ask for the cash pay rate if your deductible has not been met yet. Our average diagnostic ultrasound cash rate is $250 and we tell anyone who calls, how about that for low prices and total transparency. Good luck finding a congressperson to talk about lowering the actual prices and cost of healthcare.

  4. maisie

    Thanks for your article I want to ask, I have bone pain, should I choose which health insurance type? HDHP or insurance that has a high premium?

    please respond