High Deductible Health Plans - Excellus Prospect

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What is a HDHP?

A high deductible health plan, also known as a HDHP, has a lower monthly premium, but you’ll pay for most of your care until you meet your deductible. When a HDHP is paired with a Health Savings Account, you can set aside tax-free money for current health care expenses and build savings for the future. Learn more about how to manage your costs with a HDHP plan - Opens a dialog" .

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There are a few things you need to know:

Deductible: This is the amount you pay first before sharing your costs with us.

Copay: A fixed amount, like $25 you pay when you receive care or pick up a prescription.

Coinsurance: This is similar to a copay but instead of a fixed dollar amount, it is a percentage of the total bill. For example, if your child’s eyeglasses are $100 and you’ve met your deductible, your coinsurance payments of 50% would be $50. We would pay the rest, or $50.

Out-of-pocket maximum: This is the most you could ever pay in a year on covered health care services, excluding your monthly premium. Any deductible, copay, coinsurance or out-of-pocket cost for covered services goes towards your out-of-pocket maximum. If you reach this amount, all you need to do is to continue paying your monthly premium. We’ll pay 100% of the cost when you get care for covered services.

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Estimate Healthcare Expenses

See our Out-of-Network CostsOut-of-Network Costs examples. You may also visit Fair Health’s website (www.fairhealthconsumer.org) to estimate potential out-of-network out-of-pocket expenses. Please note: Medicare cost information may be found at CMS.gov fee schedule search tool.

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Know your deductible

Deductibles add up in different ways, so an important step in managing your HDHP plan is understanding how you reach your deductible. It depends on on the type of plan you have.

If you have the Base, Bronze Standard HSA, Bronze Standard, Silver Standard, Gold Standard or a tiered plan, here’s how your deductible adds up:

Each person only has to pay his or her own deductible on the plan. For example, Dan, Melanie and Ruby have a deductible of $1,200 for the family. Say Dan meets his $400 deductible. He would start paying copays (a fixed amount, like $25) or a coinsurance (a percentage of the total bill) for his care. Then, any combination of the remaining family members can meet the remaining $800 deductible. Once they reach that amount, everyone will only pay a copay or coinsurance for their care.

If you have the Bronze Select or Silver Select plans, here’s how your deductible adds up:

All family members in any combination will pay toward meeting the family deductible. For example, Eric and Jess have a family deductible of $5,000. They are going to pay the full cost of their care until together they reach $5,000. Once they reach that amount, they both will pay only a copay (a fixed amount, like $25) or a coinsurance (a percentage of the total bill) for their care. If it’s just one person on the plan, then you will only pay one deductible.

All plans cover the prescriptions that you rely on.

The difference is in how much you have to pay for your prescriptions. With some plans, you pay the full cost until you reach your deductible. With other plans, you pay a copay for your prescription. If your plan includes a deductible and you use diabetic drugs and supplies, you will have to pay the full cost until you meet your deductible. If you’re not sure how much it might cost, call the number listed on the back of your member card.


Tax-free funding account

You also have the option to set up a unique account called a Health Savings Acccount or HSA to help you cover qualified medical expensesOpen a PDF qualified medical expensesOpen a PDF. It’s a tax-free account that you you can roll over each year. Talk to a financial planner about setting up an HSA.


Funding Account Options for your HDHP

Talk to your employer or benefits administrator about what funding options might be available for you for your HDHP.


HDHP Tips and Tricks

Take advantage of free preventive care like immunizations and screenings. Nearly all preventive health programs are covered under our plans

Getting lab work done? All routine lab work ordered by your physician may not be covered at 100%. Customer Care Advocates are available to answer any questions you may have.

If you're on a high deductible plan such as Bronze Standard HSA or Silver and Bronze Select plans, set up a Health Savings Account(HSA)to pay out-of-pocket expenses.

Create a savings account you only use for you health care expenses. Check with your bank to see what options may be available.

Get a credit card with a low interest rate that you can use for health related expenses.

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