How to Know if You Have a High Deductible Health Plan
Unsure about your health plan? Learn to identify if it's high-deductible and understand its financial and coverage implications.
Understanding your health insurance plan is an important step in managing healthcare costs and making informed financial decisions. High Deductible Health Plans (HDHPs) have become a common option, particularly due to their association with tax-advantaged savings accounts. Knowing whether your plan qualifies as an HDHP can significantly impact your financial planning for medical expenses.
Criteria for a High Deductible Health Plan
A High Deductible Health Plan (HDHP) is defined by specific annual criteria set by the Internal Revenue Service (IRS). These criteria primarily involve minimum deductible amounts and maximum out-of-pocket expense limits that a plan must adhere to in order to be classified as an HDHP. For the calendar year 2025, a health plan qualifies as an HDHP if it has an annual deductible that is not less than $1,650 for self-only coverage. For family coverage, the minimum annual deductible required is $3,300.
These figures represent the threshold before the plan begins to pay for covered medical expenses, excluding certain preventive care services. In addition to the minimum deductible, an HDHP must also limit the total annual out-of-pocket expenses. For 2025, these expenses, which include deductibles, co-payments, and coinsurance but do not include premiums, cannot exceed $8,300 for self-only coverage. For family coverage, the annual out-of-pocket maximum is capped at $16,600.
These limits represent the most a covered individual or family will pay for in-network services during a plan year before the plan covers 100% of eligible costs. These figures are subject to annual adjustments by the IRS to account for inflation. The IRS typically releases these updated amounts, which can influence whether a health plan continues to meet the HDHP definition from one year to the next. Certain preventive care services are often exempt from the deductible requirement, meaning they may be covered at 100% even before the deductible is met. This allows individuals to access essential screenings and preventive care without incurring immediate out-of-pocket costs.
Locating Your Plan’s Specifics
Determining if your specific health plan meets the established HDHP criteria requires reviewing your plan documents. The Summary of Benefits and Coverage (SBC) document is a standardized form that all health plans are required to provide, offering a clear and concise summary of your plan’s benefits and costs. This document is an excellent starting point, as it typically outlines your deductible and out-of-pocket maximum amounts. You can usually find your SBC on your insurance company’s website, through your member portal, or by contacting their customer service department.
Beyond the SBC, more detailed plan documents, such as the Evidence of Coverage (EOC) or policy booklet, will contain comprehensive information about your plan’s structure. These documents provide a thorough breakdown of covered services, cost-sharing responsibilities, and any exclusions. If you obtain health insurance through your employer, your human resources (HR) department can also provide these documents or guide you on where to access them.
Once you have identified your plan’s specific deductible and out-of-pocket maximums, you can compare these figures against the IRS HDHP criteria for the current year. If your plan’s annual deductible meets or exceeds the minimum deductible amount set by the IRS for self-only or family coverage, that is one step towards qualification. Similarly, if your plan’s out-of-pocket maximum falls at or below the IRS-mandated maximum for self-only or family coverage, it satisfies the second crucial component. When both conditions are met, your health plan likely qualifies as a High Deductible Health Plan, aligning with federal guidelines.
Eligibility for a Health Savings Account
Being covered by a High Deductible Health Plan (HDHP) is a primary requirement for eligibility to contribute to a Health Savings Account (HSA). An HSA is a tax-advantaged savings account that can be used for qualified medical expenses, offering several financial benefits to eligible individuals. This direct connection means that if your health plan does not meet the specific HDHP criteria set by the IRS, you generally cannot contribute to an HSA.
Beyond HDHP coverage, there are other common eligibility requirements for opening and contributing to an HSA. You generally cannot be covered by any other non-HDHP health insurance, such as a spouse’s plan that is not an HDHP, unless it is permissible “other health coverage” like specific accident insurance, disability, dental care, vision care, or long-term care insurance. Additionally, you cannot be enrolled in Medicare, nor can you be claimed as a dependent on someone else’s tax return.
HSAs offer notable tax advantages, making them an attractive savings vehicle for healthcare costs. Contributions are tax-deductible, reducing your taxable income for the year. The funds in the account grow tax-free, and withdrawals for qualified medical expenses are also tax-free. This “triple tax advantage” provides a significant incentive for eligible individuals to save for current and future healthcare needs. The IRS also sets annual contribution limits for HSAs, which vary based on whether you have self-only or family HDHP coverage, with an additional catch-up contribution permitted for individuals age 55 and older.