Make the most of a high-deductible health plan

Summary

Life Kit (NPR)
Episode: Make the most of a high-deductible health plan
Host: Marielle Segarra
Date: April 20, 2026

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Main Theme

This episode of Life Kit unpacks the realities and navigational tactics of high-deductible health plans (HDHPs)—a common but often confusing type of health insurance in the US. Host Marielle Segarra, alongside reporter Jackie Fortier, draws from expert voices and real-life stories to deliver a practical guide for maximizing your coverage, avoiding costly pitfalls, and making smart use of Health Savings Accounts (HSAs).

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Key Discussion Points and Insights

1. Understanding High-Deductible Health Plans

• Defining Premiums and Deductibles
  HDHPs offer lower monthly premiums but require you to pay more out of pocket before insurance kicks in.
  • Jackie Fortier explains: “Your deductible is the amount that you have to pay for covered services before your insurance starts sharing costs.” (00:44)
• "Sticker Shock" for the Uninitiated
  Many are drawn in by low premiums without understanding the financial burden of high deductibles.
  • Story: Madison Burgess, an elementary teacher, chose the cheapest plan and was shocked her husband needed to meet a nearly $6,000 deductible before coverage began. (01:20)

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2. Takeaway 1: Know Your Costs Upfront

• Find Out Your Deductible:
  Check your insurance card or online portal to see your annual deductible.
  • “If you go to the doctor, remember, you might have a lot of bills to pay up front.” – Marielle Segarra (04:21)
• Upfront Billing Impact:
  Instead of flat co-pays, you pay the full negotiated rate for services until you meet your deductible.
  • Example: A $30 copay in a traditional plan might become a $130+ charge under an HDHP for the same visit. (04:38)

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3. Takeaway 2: Managing Immediate Medical Expenses

• Financial Assistance/Charity Care:
  Even if you haven’t met your deductible, you may qualify for reduced or wiped-out hospital bills based on your income. (05:44)
• Interest-Free Payment Plans:
  Most hospitals and providers will set up no-interest payment plans so you can pay large bills in manageable installments.
  • "Ask the billing office to put you on an interest free payment plan. That way you can pay in installments every month without accruing interest." – Marielle Segarra (05:44)
• Behavioral Impact:
  Many with HDHPs delay or skip care unless absolutely necessary due to upfront costs.
  • Example: Thomas Lehman, a dog walker, said, “We only use it for maybe emergencies or semi emergencies...I would go to the doctor more if I had more traditional insurance.” (05:03)

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4. Takeaway 3: Be Strategic with Scheduling

• Timing Expensive Procedures:
  If you anticipate significant medical expenses, consider scheduling them earlier in the year. Once the deductible is met, subsequent care is less expensive for the remainder of the year.
  • “There is an advantage to meeting your deductible earlier in the year if you can.” – Jackie Fortier (06:59)
  • “You might want to schedule those treatments up front...so you get to enjoy that kind of safety cushion.” – Jackie Fortier (07:16)

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5. Takeaway 4: Some Services are Always Free

• Preventive Services Covered:
  Federal law requires coverage for many preventive services at no cost, even before your deductible is met (e.g., annual checkups, vaccines, cancer screenings).
  • “Even if you have a high deductible plan, many preventive services must be covered by law with no out of pocket costs from you.” – Jackie Fortier (08:58)

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6. Takeaway 5: Open and Use a Health Savings Account (HSA)

• What is an HSA?
  HSAs are tax-advantaged accounts for those with HDHPs to set aside pre-tax money for medical expenses.
  • “You can think of them like a medical piggy bank. It also has a triple tax advantage.” – Jackie Fortier (10:03)
  • “Don't sleep on your HSA. It can save you a lot of money in taxes and help you save up for medical bills.” – Marielle Segarra (10:47)
• Eligibility and Contributions:
  Most with an HDHP can open an HSA; contribution limits for 2026 are $4,400 for individuals/$8,700+ for families. (11:11)
• How to Use:
  HSAs cover many expenses (doctor visits, prescriptions, OTC meds). The funds never expire and roll over year to year. (11:58)
• Investing Your HSA:
  Once your HSA hits a certain balance, you can invest the funds tax-free for long-term growth. (12:48)
• FSA vs. HSA:
  Flexible Spending Accounts are employer-sponsored, "use-it-or-lose-it" within the year, and not directly tied to HDHPs. (13:17)

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7. Pro tip: Sometimes Paying Cash is Cheaper

• Compare Costs:
  Some clinics offer lower costs for cash payments, but these payments don’t usually count toward your deductible or out-of-pocket maximum.
  • “You do have the right to an itemized estimate...then you can compare that price with what your insurance company tells you it would cost...” – Jackie Fortier (13:53)

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Notable Quotes and Memorable Moments

• “I just looked for the cheapest thing and I didn’t know what a deductible was. I just went with what was cheap and now I have regret.” — Madison Burgess (01:20)
• “You might pay, you know, $100 for the same doctor visit.” — Jackie Fortier (03:59)
• “We only use it for maybe emergencies or semi-emergencies.” — Thomas Lehman (05:03)
• “A lot of people paying their health insurance premiums and medical costs, they can only contribute a little bit. But the amount you put into the account is totally up to you.” — Jackie Fortier (11:11)
• “Investing your HSA funds may not be an option for you right now. But if you can afford to let the money sit in there and grow, this can be a great long term investment.” — Marielle Segarra (12:48)

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Important Timestamps

• 00:44 – Defining deductibles (Jackie Fortier)
• 01:20 – Real-world story: Madison Burgess’ deductible mistake
• 03:35 – What counts as a “high” deductible
• 05:03 – How upfront costs change health-seeking behavior (Thomas Lehman anecdote)
• 05:44 – Managing upfront costs: charity care & payment plans
• 06:59–07:16 – Benefits of hitting your deductible early
• 08:58 – Preventive care covered at no cost under HDHPs
• 10:03–10:47 – The power and eligibility of HSAs
• 13:17 – HSA vs. FSA basics
• 13:53 – When paying cash might beat using insurance

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Episode Recap (15:05)

• Takeaway 1: Expect significant up-front health costs with HDHPs.
• Takeaway 2: Utilize financial assistance or interest-free payment plans.
• Takeaway 3: Strategically schedule costly care earlier in the year to maximize insurance coverage.
• Takeaway 4: Preventive care is free—even before you meet your deductible.
• Takeaway 5: HSAs are powerful savings and investment tools for your healthcare expenses.

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For further help or to share your health insurance story, find the link in the show notes.

Transcript

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[Marielle Segarra]

You're listening to Life Kit from NPR. Hey, it's Marielle. Today we're talking about health insurance, specifically high deductible health plans. High deductible health plans are common in the US A lot of people choose them because they have much cheaper premiums. And premiums are what you pay every month just to have the insurance, even if you don't use it. If you get your insurance through work, these will come out of your paycheck. The thing is, high deductible plans also have high deductibles.

[Jackie Fortier]

Your deductible is the amount that you have to pay for covered services before your insurance starts sharing costs.

[Marielle Segarra]

This is Jackie Fortier. She's been reporting on high deductible health plans for an NPR and KFF health news series called Healthcare Helpline. Now, sharing costs means that after you've paid a certain amount out of pocket, your deductible, your insurance will pay a portion of each medical bill and you'll pay the rest. Could be an 8020 split, 70, 30 split. It depends on your plan. A lot of folks sign up for high deductible plans because of the cheap premiums, but then they get surprised.

[Jackie Fortier]

Later I talked to Madison Burgess. She's an elementary school teacher in San Diego and and she was shopping around for a good deal for her husband. And when I initially got the plan, I just looked for the cheapest thing and I didn't know what a deductible was. I just went with what was cheap and now I have regret. So her husband has to meet an almost $6,000 deductible before insurance will pay.

[Marielle Segarra]

If you signed up for a high deductible health plan and now you're wondering how do I use this thing? We are here to help on this episode of Life Kit, a playbook for using your high deductible health insurance plan. One tip as a preview, if you know you have to get an expensive procedure or surgery or test done, try to time it out so you meet your deductible as early in the year as possible.

[Jackie Fortier]

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[Jackie Fortier]

Hey Marielle.

[Marielle Segarra]

You mentioned that someone you interviewed has to meet a $6,000 deductible before insurance will start paying for their care. Is that common?

[Jackie Fortier]

Yeah, it's kind of middle of the road. The IRS actually defines high deductible health plans. The minimum deductible for this year is $1,700 for an individual. Some individual, like catastrophic deductibles, can exceed $10,000 for a single person a year.

[Marielle Segarra]

That would be a pretty big shock if you haven't had a high deductible plan before.

[Jackie Fortier]

Yeah, and I think high deductible plans can be like confusing because the timing of the costs is so different. So under a traditional plan, you might pay like $20 copay to see your doctor, but under a high deductible plan, you pay the full negotiated price of the visit until you hit your deductible. So you might pay, you know, $100 for the same doctor visit.

[Marielle Segarra]

Takeaway 1 if you have a high deductible plan, find out what your deductible is. If you take out your insurance card, it'll probably be on there. Or you can also look in your portal online or in your plan documents. And then if you go to the doctor, remember, you might have a lot of bills to pay up front.

[Jackie Fortier]

These can range.

[Marielle Segarra]

You know, maybe you're used to paying a $30 copay when you go to see the doctor or. But now the office is asking you to pay $130 for the same visit or you get a blood test done and you have to pay a couple hundred dollars for that. So one of the challenges, right, is that when you have a high deductible plan, you end up with a lot of upfront costs. How does that play out for a lot of folks?

[Jackie Fortier]

I think it really changes how some people choose to use their health Care. I talked with Thomas Lehman. He's a dog walker and pet sitter in the Atlanta suburbs. And he's had a high deductible plan for a few years now. You know, he spends thousands of dollars a year just on premiums. That doesn't leave a lot left over. So he and his wife only see a doctor when it really feels unavoidable. So we're kind of stuck in this situation where I mean, we only use it for maybe emergencies or semi emergencies. And he told me that he would go to the doctor more if he had more traditional insurance. But with a high deductible plan, he's not comfortable doing that. So he only goes when he feels like he really has to.

[Marielle Segarra]

Takeaway two, though, is there are ways to manage these upfront costs. At Life Kit, we've reported on how to apply for financial assistance, also known as charity care, from a hospital. Even if you haven't met your deductible yet, hospitals might lower or eliminate your bill, depending on your income. Another option is to get on an interest free payment plan with your hospital or doctor's office. And here's how that works. Imagine it's January. You have a $6,000 deductible and you have to go to the hospital for something. Then you get a bill and it's $2,000. You're expected to pay that bill directly to the hospital because you haven't hit your deductible yet. But that doesn't mean you have to pay it off all at once. Ask the medical billing office to put you on an interest free payment plan. That way you can pay in installments every month without accruing interest. Now, it is possible that when you ask, they'll say no. But these types of payment plans are very common. And to be clear, we're not talking about signing up for a credit card or a loan. This is just an installment plan that you set up with the billing office. And before you start paying, you want to confirm in writing that you won't be charged any interest. Another strategy if you have a high deductible health plan is to see if you can benefit from timing your healthcare visits so that if you're going to hit your deductible, you do it early in the year.

[Jackie Fortier]

There is an advantage to meeting your deductible earlier in the year if you can. I talked with Caitlin Donovan with the Patient Advocate foundation and she said it does pay off to sort of strategically schedule those big ticket medical treatments.

[Marielle Segarra]

You might want to schedule those treatments

[Jackie Fortier]

up front a surgery up front, so that way you're paying for your coverage and then the rest of it kicks in for the rest of the year and you get to enjoy that kind of safety cushion. So most deductibles reset on January 1st and again if you can afford it. Meeting your deductible sooner can make the rest of the year significantly cheaper, especially if you have a chronic condition.

[Marielle Segarra]

This is our third takeaway. Be strategic about when you schedule expensive procedures and visits whenever possible. Of course, if you've already met your deductible in a given year, that's also a good time to get your expensive medical care done. We'll have more Life Kit after the break.

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[Marielle Segarra]

Now onto takeaway four Certain kinds of visits and services are free even if you have a high deductible plan and haven't met your deductible yet.

[Jackie Fortier]

This one surprises a lot of people. As with most insurance in the us even if you have a high deductible plan, many preventive services must be covered by law with no out of pocket costs from you. So this includes things like annual checkups, many vaccines and immunizations and screenings for a lot of cancers. The there is a whole list and these services are free when you go to an in network provider, so you should really take advantage of those.

[Marielle Segarra]

If you're on a high deductible health plan, how can you budget for the upfront costs that we've been talking about?

[Jackie Fortier]

It's really important to treat your deductible like a bill that you might have to pay. It doesn't mean that you're going to hit it every year, but if you have like a $4,000 deductible, it can help to slowly set aside money during the year so that a surprise medical issue doesn't become a huge financial cris. Some people essentially build their own medical emergency fund and there is a Way to help you do that. It's called a health savings account, an hsa.

[Marielle Segarra]

Can anyone with a high deductible plan open an hsa?

[Jackie Fortier]

If you have a high deductible plan, you very likely can open an HSA new this year. Folks with bronze or catastrophic ACA plans can open an hsa. There are a few people who can't because of their individual circumstances. They so if you have other health insurance like Medicare or you have coverage on your spouse's policy, you cannot open an hsa. Or if you're claimed as a dependent, a lot of people who have a high deductible plan don't actually open an hsa, but they are pretty neat. You can think of them like a medical piggy bank. It also has a triple tax advantage. You put money in before taxes, it grows tax free and then you can spend that money tax free on, on qualified medical expenses.

[Marielle Segarra]

Takeaway 5. Don't sleep on your HSA. An HSA is a savings account for medical expenses. The money you put into it will not be taxed. It either comes straight out of your paycheck before taxes or you can put it into your account and get a tax deduction in April, your HSA account belongs to you. If you open one through an employer and you leave your job, the money is still yours. And the money rolls over every year.

[Jackie Fortier]

It is important, I think, to remember if you don't have a lot of extra cash to put into an hsa, you are not alone. A lot of people paying their, you know, health insurance premiums and medical costs, they can only contribute a little bit. But the amount that you put into the account is totally up to you. So you can start like really small if you want to, like just a few dollars a month if you want to slowly build it up. There is an annual limit set by the irs. So it's based on the number of people on the policy. For 2026, it's $4,400 for an individual and a little over 8,700 for families. So anything under that ceiling that you want to put into an HSA is completely up to you.

[Marielle Segarra]

What sorts of things can you use the money in your HSA on?

[Jackie Fortier]

You can pay for quite a bit. You can pay for those doctor visits like we talked about earlier. Prescriptions, even products like over the counter medicines, tampons, sunscreens. You get issued a debit card from the bank where you open the account and that's how you buy anything. And that money is yours. There's no deadline to use typically cannot be used for monthly premiums. But again, you do get to keep that money for any of these qualified medical expenses for you, your spouse or your dependents anytime in the future. If you get insurance through your job, your employer may match the amount that you put into the HSA up to a certain point. Or they could just add fund. You could ask your HR department about the details on that. If you buy your insurance through the exchange, though, you do have to fund the HSA yourself.

[Marielle Segarra]

Another thing that's nice about HSAs is that you can invest the money in your account in stock market funds, usually once you hit a certain threshold. And you'll never be taxed on that money, not even the growth, as long as you eventually use it for qualified medical expenses when you do withdraw it. Investing your HSA funds may not be an option for you right now. But if you can afford to let the money sit in there and grow, this can be a great long term investment. Keep in mind that HSAs are different from FSAs or flexible spending accounts.

[Jackie Fortier]

It's funny, they get mixed up a lot because they're both these like taxed advantaged healthcare accounts that you fund, but they do work differently. So a flexible spending account is more like a short term budgeting tool for that year. This is an employer sponsored benefit, so it's owned by your employer. You usually have to use it or lose the money by the end of the year. It does not require a specific type of health plan. It is also tax free for qualified medical expenses, but only when you're employed at that job.

[Marielle Segarra]

Okay, anything else that folks with high deductible health plans should know?

[Jackie Fortier]

One other thing that people might be considering is paying cash when it's time to pay for your care. You know, some people think it's maybe more affordable to skip using insurance. Some hospitals or clinics will offer cheaper prices if you pay cash because they want to get paid. You do have the right to an itemized estimate, an explanation of how much a health service would cost if you paid out of pocket. So if you have time before you go and get that service, you could go and ask them how much it would be, and then you can compare that price with what your insurance company tells you it would cost if you used your insurance. So paying cash may save you money. But remember, the amount you pay generally won't count toward your deductible or your out of pocket maximum because you're not going through your insurance. So if you're able to usually before you know, like a surgery for example, that you might have planned. You might be able to do the math on how much it would cost if you paid cash versus how much it would cost if you went through your insurance.

[Marielle Segarra]

Jackie, thank you so much for this.

[Jackie Fortier]

Yeah, thank you.

[Marielle Segarra]

Okay, time for a recap. Takeaway 1 if you have a high deductible plan, remember you might have a lot of bills to pay up front. Takeaway 2 There are ways to manage these costs. At Life Kit, we've reported on how to apply for financial assistance, also known as charity care, from a hospital. Even if you haven't met your deductible yet, hospitals can lower or eliminate your bill based on your income. Another option is to get on an interest free payment plan with your hospital or doctor's office. Not a credit card or a loan, just an installment plan with zero interest. Takeaway 3 if you think you're going to meet your deductible, you want to schedule expensive medical procedures and visits earlier in the year so that you can squeeze the most out of your plan. Of course, this isn't always possible and if you've already met your deductible in a given year, that's also a good time to go to the doctor. Takeaway 4 Certain kinds of visits and services are free even if you have a high deductible plan and you haven't met your deductible yet. And takeaway 5 don't sleep on your HSA. It can save you a lot of money in taxes and help you save up for medical bills. That's our show do you have a question or a story about navigating the healthcare system? It could be part of an upcoming Healthcare Helpline installment. You can share your story by following the link in the show. Notes of this Episode this episode of Life Kit was produced by Margaret Serino. Our digital editor is Malika Garib and our visuals editor is CJ Ricolon. Meghan Cain is our senior Supervising Editor and Beth Donovan is our Executive producer. Our production team also includes Andy Taegle, Claire Marie Schneider, Sylvie Douglas and Mika Ellison. Engineering support comes from Code Takasugi Chernovin. I'm Marielle Segarra. Thanks for listening.

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[Marielle Segarra]

Dr. Eric Topol says health influencers make big claims about longevity, but he's offering us a reality check.

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We can accept that we're going to age, but we don't have to accept heart disease and cancer or neurodegenerative diseases.

[Marielle Segarra]

Straight talk about how to grow old and stay healthy. That's on the TED Radio Hour podcast. Listen on the NPR app or wherever you get your podcasts.