United States
Hong KongHigh deductible health plans
A high deductible health plan carries a deductible above a federally set floor and an out-of-pocket maximum below a federally set ceiling, which is what makes it qualify to pair with a health savings account. Preventive care is generally covered before the deductible is met.
The high deductible plan is the insurance half of a two-part product. On its own it is an ordinary major medical plan with the deductible turned up. Paired with a health savings account it becomes something different, which is why the outline lists the two together in one sub-item.
What makes a plan qualify
- A deductible at or above a minimum set in federal law.
- An annual out-of-pocket maximum at or below a federal ceiling.
- No benefits payable before the deductible is met, other than preventive care.
- The member holding no other disqualifying coverage that pays before the deductible.
Those thresholds are federal figures that are adjusted every year. We hold no federal tax source, so this page names none of them, and neither does the content outline. The examinable point is that a qualifying plan is defined by a floor on the deductible and a ceiling on total exposure.
The preventive care exception, which is the interesting one
A high deductible plan may cover preventive services before the deductible is satisfied without losing its qualifying status. That exception exists because the whole design depends on members not skipping the cheap care that stops expensive care being needed later.
It is the cleanest exam question available on this topic. The rule looks inconsistent with the plan's own logic right up until you see the reason for it, and a stem that describes a covered physical before any deductible has been met is testing exactly that.
The trade the member is making
| Traditional plan | High deductible plan with an account | |
|---|---|---|
| Premium | Higher | Lower |
| Cost of routine care | Copayment, plan pays most | The member, from the account or their pocket |
| Catastrophic protection | Yes | Yes, once the deductible is met |
| Unused money at year end | Nothing to keep | Stays in the account |
| Who feels the price of care | The plan | The member |
That bottom row is the policy argument for the whole design and it is worth naming honestly. A member paying for routine care out of their own account has a reason to ask what things cost. Whether that produces better decisions or deferred care is an argument the exam does not enter, and neither will we.
A member covered by a qualifying high deductible plan has an annual physical, which the plan pays for in full before he has met any of his deductible. Does this disqualify the plan?
- Yes, because a qualifying plan may pay nothing before the deductible
- No, because preventive care is an express exception
- Yes, unless the member repays the cost into his account
- No, because annual physicals are not medical care
Where it sits
- Section
- V, types of accident and health policies, 16 questions
- Listed as
- Medical expense, sub-item 7, with related health savings accounts
- Neighbors
- Flexible spending accounts at 6, health reimbursement accounts at 8
- Our estimate for the three accounts and HDHP together
- 1 or 2 questions, ours and not published
The opinion, and the concession
Learn this immediately after the three accounts, in the same sitting, because half the questions available here are really about the pairing. The plan qualifies, so the account is allowed. The account exists, so the plan's deductible is affordable. Studied separately, each half looks arbitrary.
The concession: everything numeric about this topic is federal and annual, and we hold no source for any of it. That is a genuine gap in what this page can tell you, and we would rather leave it visible than fill it with a figure from a study guide whose provenance we cannot check. The outline asks about the structure, not the thresholds.
Common questions
What makes a health plan a qualifying high deductible plan?
A deductible at or above a federal minimum, an out-of-pocket maximum at or below a federal ceiling, and no benefits payable before the deductible other than preventive care. Those thresholds are adjusted annually and this site does not print them, because we hold no federal source that sets them.
Can a high deductible plan cover anything before the deductible?
Preventive care, yes, without losing its qualifying status. The exception exists because the design depends on members not skipping cheap care that would prevent expensive care later. It is also the most testable single fact about these plans.
Do you have to open a health savings account?
No. The plan and the account are separate things, and someone can hold a qualifying high deductible plan without opening an account at all. What is not possible is the reverse: an HSA requires qualifying coverage, so the account cannot stand on its own.
Why are high deductible plans cheaper?
Because the member absorbs the first slice of every claim, so the plan pays fewer and smaller ones. The catastrophic protection is still there once the deductible is met. What the member is buying is protection against the large bill rather than help with the routine one.