When federal enhanced marketplace subsidies ended at the close of 2025, many people shopping for coverage saw their monthly premiums jump and switched to high-deductible health plans (HDHPs) to save on monthly costs. HDHPs lower your premium but raise the amount you must pay out of pocket when you need care. For example, an elementary school teacher in San Diego, Madison Burgess, chose a cheaper bronze plan for her family and later discovered she faced a $5,800 family deductible before most coverage kicked in.
Key terms
– Deductible: the amount you pay out of pocket before your insurance begins paying.
– Premium: the recurring monthly payment you make to your insurer.
Why HSAs help
A health savings account (HSA) is a useful tool if your plan is HSA-eligible. HSAs let you save pretax dollars for qualified medical expenses and typically come with three tax advantages: contributions reduce taxable income (or are made pretax), the account balance grows tax-free, and withdrawals for qualified medical care are tax-free. Eligible HDHPs include many bronze and catastrophic marketplace plans as well as employer plans labeled HSA-compatible.
Qualified expenses commonly include doctor visits, prescriptions, and many over-the-counter items such as medications, tampons, and sunscreen. HSA funds generally cannot be used to pay regular monthly premiums. An HSA belongs to you — it rolls over year to year and stays with you if you change jobs or insurance. That contrasts with most FSAs (flexible spending accounts), which are employer-run, may forfeit unused balances at year-end, and don’t follow you between jobs.
How to open and use an HSA
You can open an HSA through a bank, credit union, brokerage, or other financial institution that offers HSA custodial accounts; many provide debit cards for HSA spending. If you get insurance through an employer, your employer may require using a specific custodian. Compare fees, investment options, and account features before choosing.
You don’t need to contribute large sums to benefit. Small, regular deposits help build a cushion for unexpected costs. The IRS sets annual contribution limits—for 2026 those limits are $4,400 for individuals and $8,750 for families—so stay within those caps when planning contributions.
Preventive care and cost shopping
Marketplace plans are required to cover certain preventive services at no cost when received in-network. That includes routine immunizations and some screening tests. Beyond preventive care, costs can vary widely by setting: telehealth, an urgent-care clinic, or an in-network primary-care visit can have different price structures. Review your plan’s summary of benefits to see which services are covered and how cost-sharing works.
Timing care and deductible strategy
Most plan deductibles reset on January 1. If you learn early in the year that you or a family member will need ongoing care or procedures, scheduling necessary appointments earlier in the year can be helpful: once you meet the deductible, additional covered care for the remainder of that plan year will typically be cheaper. If you can afford to pay toward the deductible sooner, doing so can sometimes save money overall.
When to pay cash instead of using insurance
Some providers offer lower cash prices than what you’d be billed through insurance. Before care, you have the right to request an itemized good-faith estimate of out-of-pocket costs. Compare that estimate with your insurer’s projected cost after applying the deductible. If a cash price is lower and you prefer paying up front, make sure charges aren’t submitted to your insurer (because submitting them could trigger higher billed rates). Keep in mind cash payments typically won’t count toward your deductible or out-of-pocket maximum, so paying cash can make sense mainly if you don’t expect to reach your deductible.
If you use the marketplace, keep income information current
If you receive premium tax credits through the marketplace, report income or household changes as soon as they happen. A raise, a new job, a side gig, or a change in household size can affect your subsidy amount; failing to update your information can result in having to repay some or all of the subsidy at tax time. Contributing to an HSA reduces your taxable income, which may help offset subsidy changes, but it’s generally better to report income changes and adjust your plan or contributions during the year rather than face a surprise reconciliation bill on your tax return.
Bottom line
High-deductible plans can be a cost-effective way to lower monthly premiums, but they increase the amount you may have to pay up front for care. If your plan is HSA-eligible, open an HSA, contribute what you can within IRS limits, and use it to pay qualified medical costs tax-free. Review preventive benefits, shop different care settings and prices, consider timing care early in the year if you anticipate ongoing needs, compare cash prices versus billed insurance costs, and keep any marketplace income information up to date.
If you have a confusing bill or a tricky coverage question, resources like Health Care Helpline from NPR and KFF Health News gather people’s stories and help navigate the health system. Sharing your experience can also help others learn how to manage HDHPs and HSAs more effectively.