A high deductible health plan (HDHP) with a
health savings account (HSA) provides medical coverage and a tax-free way to save for future medical expenses. Like it sounds, a high deductible health plan is a health insurance plan that has a high deductible (the amount of medical expenses that you must pay for out of pocket before your insurance coverage kicks in). Once the deductible has been met, eligible healthcare expenses will be covered by the plan.
A high deductible health plan does not usually cover any healthcare costs until the deductible has been met. That means that you will be responsible for most healthcare costs until you meet your deductible. However, most plans pay for preventive services—such as an immunization—before the deductible is met. Not all high-deductible plans work the same so it is important to review the plan’s coverage details carefully. It is a good idea to find out from your insurance provider which services are covered, and what your out-of-pocket expenses will be, both before and after you meet your deductible.
Routine healthcare that includes check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems will be considered preventive services. Services generally considered to be preventive services are listed below*:
- Physicals, including gynecological exams (without a medical diagnosis)
- Well child visits
- Most screening lab tests (customary tests associated with a physical)
- Most immunizations – possible exceptions include shingles vaccine (Zostervax) if under age 60, and travel vaccines
- Many cancer screenings, including mammograms and colonoscopies (coverage of these services is typically based on age, gender and health status)
*Please contact your insurance company to determine your actual benefits and the cost for these services. Your insurance company should be able to quote you the contracted rate based on the “billing code." Please note that UW Medicine cannot change the billing of services from medical to preventive after the service has been rendered.
Medical Condition Services
Services that are for the treatment of illness will be considered a "medical condition" service (not a preventive service) and may be applied to the deductible. Below are billing codes for the most common services that may be billed for "medical conditions":
|Medical condition services||Lab services|
|New Patient Visit Level I 99201||Glucose 82962|
|New Patient Visit Level II 99202||Hemoglobin 85018|
|New Patient Visit Level III 99203||Hemoglobin A1c 83036|
|New Patient Visit Level IV 99204||Urine Pregnancy Test 81025|
|New Patient Visit Level V 99205||Prothrombin Time 85610|
|Established Patient Visit ‐ Nurse 99211||Strep Test, Rapid 87880|
|Established Patient Visit ‐ Level II 99212||Urinalysis, Auto Dipstick 81003|
|Established Patient Visit ‐ Level III 99213 (most commonly billed)||Wet Prep/KOH test 87210|
|Established Patient Visit ‐ Level IV 99214 (most commonly billed)|| |
|Established Patient Visit ‐ Level V 99215|| |
|Blood Draw Fee 36415|| |
|X‐Ray Chest 71020|| |
|Facility Fee G0463|| |
Codes are chosen based on time and/or medical complexity of the service. Actual codes will be determined at the time of the service. For services not listed here, including procedures (e.g. lesion removal), please ask your provider for the "billing code" and call your clinic's main number to receive a quote for the fee (within two business days). Please contact other UW Medicine clinics and hospitals for their estimated prices and billing codes.
Health Savings Account
Most individuals enrolled in HDHPs are eligible to set up a health savings account—an account that you can deposit money into without paying taxes on it (up to the legal limit). Many employers who offer an HDHP also contribute dollars to an individual employee HSA. You may withdraw money from your HSA to pay for qualified medical expenses, including dental and vision, as well as for your deductible, copays and other healthcare expenses. Or you may choose to pay your medical expenses out-of-pocket, allowing your HSA savings to grow.
Although contribution limits apply, individuals can save significant amounts of money in an HSA to be used for future healthcare costs. Unlike flexible spending programs, any unused amounts in the account at year-end continue to accumulate on a tax-free basis (instead of being forfeited). Individuals also keep their HSAs when they switch employers. Health savings accounts are a good way to save for anticipated future healthcare expenses on a tax-free basis.
Please note that if you are enrolled in Medicare, you are not eligible for an HSA.