Hello and welcome to Financial Face-off, a MarketWatch column where we help you weigh financial decisions. Our columnist will give her verdict. Tell us whether you think she’s right in the comments. And please share your suggestions for future Financial Face-off columns by emailing our columnist at [email protected].
The face-off
It’s the time of year to sign up for a new health insurance plan, either through an employer or through the government’s Health Insurance Marketplace.
The decision may feel especially fraught this year. High inflation, layoffs and a potential recession are weighing on people’s minds and finances. Americans have been tightening their budgets and may be looking for ways to save money on their health-insurance costs. One way to do that, at least in terms of upfront costs, could be to sign up for a high-deductible health plan. These plans typically have lower monthly costs (premiums), but they have higher deductibles, or, the amount of money that you have to pay out of your own pocket before the insurance kicks in to cover healthcare costs.
So is this the year to try to save some cash by signing up for a high-deductible health plan?
Why it matters
It’s no secret that healthcare is expensive in the U.S., but the language of health insurance often obscures that reality with euphemisms such as “cost-sharing,” “coinsurance,” “copay” and “deductible.” Here’s a quick translation: if you see one of those terms, just mentally replace it with a dollar sign, because it means you will be paying money.
Choosing a healthcare plan is important. Medical bills can strain a household’s finances, and healthcare debt is very common. More than half (57%) of Americans have incurred debt caused by a medical or dental expense in the last five years, according to a nationally representative survey released in June by KFF, an independent nonprofit that researches healthcare issues.
One of the survey’s more troubling findings was that even people who have health insurance fall into debt, with more than four in 10 insured adults reporting that they currently had health-related debt.
In other words, the decision about which health-insurance plan to choose can have far-reaching unintended consequences.
How much can you expect to pay for health insurance? If you get yours through your job, it depends on several factors including the size of your company and the age of its workforce. On average, workers with employer-based health insurance paid $6,106 per year toward family coverage and $1,327 for individual coverage, according to KFF. People at smaller companies typically have higher premiums and bigger deductibles.
The federal government defines a high-deductible health plan as one with a deductible of at least $1,400 for an individual and $2,800 for a family.
High-deductible health plans (HDHPs) often — but not always — come with a health savings account (HSA) where people can store money tax-free to pay for medical expenses.
“ ‘Medical debt really can be the gift that keeps on giving.’”
HDHPs have lower premiums, but are they more affordable in the long run than traditional health plans? ValuePenguin compared HDHPs vs. traditional plans in three scenarios and found that the HDHP plan holder would end up paying more overall than the traditional plan holder if they had medical expenses of $5,000 or $10,000 in a year.
However, the HDHP holder had lower overall costs than the traditional plan holder if their medical expenses were $1,000. “But banking on such an outcome — and such low need for medical care — can be a gamble in an unpredictable world,” ValuePenguin wrote.
The verdict
If you can pay the higher monthly costs, avoid a high-deductible health plan.
My reasons
“It’s very difficult to accurately predict what your health-care needs are going to be for the coming year. And for that reason, it’s a good idea to sign up for the most comprehensive plan option that you can afford,” said Karen Pollitz, a senior fellow at KFF. Buying the cheapest option can open you up to the possibility that something is going to happen — you’ll get hit by a car, find a lump — and then “you’re going to find out the hard way how much your plan doesn’t cover and what you’re going to owe out of pocket,” Pollitz said.
As the KFF survey found, medical debt is common even among people with health insurance, she noted. “There are lots of reasons for that, but high deductibles are one culprit,” Pollitz said.
That debt can have serious long-term consequences, including wrecking your credit score, or forcing you to cut back on other household expenses including essentials like groceries, utilities and rent. You may even get into a situation where doctors refuse to treat you if you’re not paying your bills on time, leading you to delay needed health care. “Medical debt really can be the gift that keeps on giving,” Pollitz said, referencing the ongoing negative impacts on people’s finances.
Is my verdict best for you?
On the other hand, HDHPs with health savings accounts attached to them can make good financial sense for “one group,” Pollitz said: people who are “wealthy enough to need a tax-preferred savings mechanism” and can afford to pay whatever health costs may arise. “Partners in law firms usually sign up for them, but the associates and secretaries usually would prefer not to,” she added.
Health savings accounts (HSAs) are a great way to grow wealth over time, said Eric Roberge, a certified financial planner and founder of Beyond Your Hammock, a Boston-based fee-only financial planning firm. “You get to contribute pre-tax dollars, and any growth on the money you invest within the HSA is tax-free as well,” he told MarketWatch. “If you withdraw money and use it on qualified medical expenses, that is also tax-free. It’s the only account that provides this triple tax advantage.” After age 65, you can use your HSA money for anything, not just medical expenses, but you will have to pay taxes on the withdrawals.
A high-deductible health plan with an HSA can work well if you are young, healthy and don’t incur a lot of medical costs. But if you use medical services frequently or have a lot of high-cost prescriptions, for example, this might not be the best option, because the cost of the high-deductible health plan might not be worth the access to the HSA, Roberge noted. “For folks who can manage their healthcare bills without issue while they’re earning an income from their job and don’t usually have a lot of medical costs each year, opting for the HDHP can not only save you on premiums each year, but it also gives you a chance to grow wealth for the long-term in a highly tax-advantaged way via an HSA,” Roberge said.
Tell us in the comments which option should win in this Financial Face-off. If you have ideas for future Financial Face-off columns, send me an email at [email protected].