Detailed insight on hdhp bcbs

HDHP BCBS

Table of Contents

The HDHP BCBS is a high-deductible health plan by the Blue Cross Blue Shield health insurer. It has a significantly higher deductible than traditional health insurance plans but much lower monthly premiums.

Your insurance plan kicks in only after you’ve met your deductible for the year, however, preventive services like screenings and immunizations are covered at no cost to you.

The Inland Revenue Service describes a high-deductible health plan to be one with a deductible for an individual at not less than $1,400 and $2,800 for a family plan. It goes on to state that the total annual out-of-pocket expenses should be a maximum of $7,050 for individuals and $14,100 for families.¹

You pay your medical bills on covered items till you’ve reached your deductible for the year after which the insurance plan kicks in. Then your insurance company starts paying its share of the costs while you continue to pay part of it called the coinsurance. You could be eligible for a health savings account (HSA) to help with the bills.²

At the point you’ve reached your out-of-pocket maximum for the year, your BCBS health insurer begins to pay 100% of the cost of all covered services while you continue to pay only your monthly premium. Your deductible and the coinsurance you paid during the insured year are what goes into calculating your out-of-pocket maximum.

These figures are not carried into the next insurance year as they are usually reset at the beginning of each year. What that means is that you’ll resume paying for most of your medical bills in the new year till you’ve met your deductible for that year before BCBS starts paying its share.

The HDHP BCBS isn’t for someone who makes frequent visits to a doctor. It’s for those in a reliable state of good health and surely won’t need such frequent hospital visits within the insured year at the least.

BCBS HDHP vs. PPO

PPO stands for preferred provider organization and is a health insurance plan that for the most part is the opposite of a high-deductible health plan. You pay higher deductibles in hdhp than in PPO but lower premiums in hdhp than you pay in PPO. Below is a table of the distinct features of both plans.

Comparison Criteria	HDHP	PPO
Insurance premiums	lower	higher
Deductible	higher	lower
Out-of-pocket Maximum	higher	lower
Network providers	Bigger	smaller
Hospital visitations	Recommended for few to non	Recommended for frequent
Health savings account	Eligible	Ineligible
Suitability for Travellers	More	Less
HDHP: High deductible health plan; PPO: Preferred provider network.

The PPO with its smaller provider network may not be suitable if you are the type that travels often. This is because of the poorer chances of finding in-network providers in other places. You get to pay much more for healthcare when you use an out-of-network provider.

The guiding principle on which of the two plans to subscribe to is the frequency of your visits to the hospital among a few other factors like:

Existence of chronic ailments.
Expected need for medical services like pregnancy.
The need for larger or smaller in-network providers.
The risk level of career or profession. etc

BCBSTX HDHP

This is part of the Health Care Services Corporation (HCSC) founded in 1929 and has its state headquarters in Richardson. It is the largest health benefits provider in Texas and covers all 254 counties with offices in Austin, Houston, and Lubbock counties as regional offices.

The bcbstx hdhp is a valuable high-deductible health plan offered to subscribers in the state of Texas. It has all the features and service delivery options that Blue Cross Blue Shield is known for just as described earlier in this article.

By working with over 80,000 healthcare providers in Texas bcbstx offers other health plans such as HMO, HMO POS, PPO, and CDHP. The Blue Cross Blue Shield of Texas also makes a provision for you to compare plans³ to choose the best for you.

HMO.

Its monthly premiums and deductibles are usually lower than other plans if you stay within its provider network. Going out-of-network may result in significantly higher bills as the plan may not cover such costs.

You’ll be assigned a primary care physician (PCP) who can also be taken to be your primary care doctor. Your PCP could be practicing in geriatrics, pediatrics, obstetrics & gynecology, or as a family medicine physician.

Your PCP plans your routine preventive check-ups, detects impending health problems, and refers you to specialists when you need one. By this, they are known to drive down your overall cost of health care.

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HMO POS.

This is similar to the HMO plan but with added benefits that give you additional flexibility. You’ll have the privilege to go out-of-network or see specialists without your PCP referral which is lacking with the HMO plan. The cost of care is covered at the point of service level.
The features or what to expect from the HMO POS plan are:

The deductibles and coinsurance costs are higher.
The Monthly premiums are higher than in an HMO plan.
The out-of-pocket maximum is lacking which leaves you paying part of the costs all the time.
Out-of-network providers may demand you pay the entire bill.
You’ll have to file claims to be reimbursed which also means you’ll have to keep records of your expenses. This is more paperwork.

PPO.

This is called the participating provider organization health plan and gives you the added flexibility of choosing the health facilities, doctors, or other recognized healthcare providers without a referral from your PCP but at added costs.

This plan has been discussed earlier in this article and it has similarities with an HMO POS. However, it typically has limitations in comparison to a BCBS hdhp and doesn’t qualify you for a health savings account (HSA).

Apart from the BCBS hdhp, it has higher out-of-pocket and monthly premium costs than other plans but you won’t have to pay higher coinsurance and out-of-network deductible in the event of an emergency.

CDHP.

This is an acronym for a Consumer-directed health plan and is designed to grant you better control over your expenses. Unlike the PPO, the CDHP allows you the use of pretax money in paying for covered health care services via a health savings account (HSA) or similar accounts.

Studies have shown the HSA significantly drives down the cost of healthcare⁴ and enable consumers to buy into high deductible health plans.⁵

Final words.

Buying health care insurance and choosing the right one for you can be pretty onerous and require professional guidance. There are resources out there to help you make the best choice. We’ve covered this in a previous article⁶.

You may also want to find out the cost of long-term care insurance.⁷ Any health care that exceeds 3 months is a long term one. Share on X A lot of people end up needing it at a point in their lives as the older you get the more likely you’ll eventually need it.

Princewill

A board-certified healthcare practitioner with over 20 years of clinical experience that touches on a broad spectrum of diseases and medical conditions. Has worked for the government at the tertiary and other levels of healthcare, consults in a couple of private healthcare facilities, and has been a board member of two well-read health magazines. Passionate about research, writing, reading, education/health awareness, religious, and charitable programs.