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The Bad - and the Good - of High-Deductible Health Plans

The least expensive healthcare plans offered under the Affordable Care Act can unfortunately wind up being the most expensive if you have a serious issue, due to their high deductibles.

These are generally the “Bronze” plans, the ones with the lowest monthly premiums. However, their deductibles (the amount you pay out of pocket before your plan starts to pay directly for services), can be up to $7150/year for an individual.

A Safety Net

If you have one of these plans and suddenly find yourself with a broken leg or serious illness, you’ll have to dig deep into your pockets, at least at first to reach that higher deductible.

When you buy a high-deductible plan, you’re taking a gamble that you’ll be healthy. But you’re also giving yourself a safety net that protects against bills you could receive in excess of that deductible.

That’s because, without your high-deductible plan, your medical bills could climb much, much higher. The federal government estimates that three-days in the hospital can cost $30,000, while comprehensive cancer care can run into hundreds of thousands of dollars. Without insurance, patients can face serious debt or even bankruptcy.

Now, For That Good News

Let’s say you did break your leg and ran up thousands in medical costs. Behind the scenes, your health plan is working on your behalf.

Insurance companies negotiate big discounts with health care providers. And as a plan member, you pay that discounted rate – even when you haven’t met your deductible.

So, the cost to you of fixing that broken leg could be $3,500, out of pocket rather than $6,000 with no insurance. Or a visit to a doctor’s office might cost you $85 instead of $150.

Just be sure to use your plan’s “in-network” doctors and hospitals for your care. (All ACA plans have very specific networks these days. So, read your policy before you need it.)

Another plus, you’re still entitled to certain free preventive care such as a physical, flu shots, or a mammogram without having to meet that deductible. So, take advantage of it!

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