HSA versus PPO: Feeling Guilty About Doctor Visits

For about eight years, my husband and I subscribed to a high-deductible health plan. Every year I renewed our insurance and hoped we would stay healthy. In the best-case scenario, we would pay lower premiums, sock money away in our HSA, and never visit the doctor’s office.

In the worst-case scenario, we would pay $6,000 towards our deductible before our insurance would pay a dime.

High Deductibles and Big Medical Bills

The monthly premiums on a high-deductible health plan typically cost much less than a low-deductible plan, but signing up for one typically means paying expensive medical bills until you meet your deductible.

If you never get sick, you win the health insurance game, but if you get injured or ill, you’ll pay thousands before your insurance benefits kick in.

And you’d be amazed by how quickly doctor’s appointments and tests add up. One year, a technician spotted architectural distortion on my yearly mammogram. Preventative policies covered my first breast exam, but follow-up tests weren’t covered. 

That’s usually how it works—your preventative benefits end when doctors or technicians spot a problem, and one follow-up test can quickly become many.

Insurance didn’t cover the call-back mammogram or ultrasound, but, of course, I couldn’t skip out on those tests. Instead, I handed over my credit card and paid $700 to find out what might come next.

Unforeseen Medical Issues

Every year unexpected medical bills seem to pop up out of nowhere.

One year doctor’s found enlarged lymph nodes while running a routine test. Investigating the issue required three ultrasounds and a trip to Johns Hopkins to rule out lymphoma.

That year we paid $5,900 worth of medical bills, which was $100 shy of meeting our yearly deductible.

HSAs and Skipping Out on Doctor’s Appointments

When we had a high-deductible health plan, I dreaded doctor’s visits. If I didn’t feel well, I hesitated to make appointments. The idea of shelling out cash for a doctor’s appointment prevented me from scheduling sick visits. So I avoided going to the doctor even when I was really ill.

In a perfect scenario, HSAs save you money. The most significant savings come from never needing to visit a doctor in the first place. If you need medical assistance, a few doctor visits can quickly snowball into thousands of dollars worth of bills.

HSAs are definitely the right choice if you rarely get sick, but who knows what the future holds? Instead of saving money, I spent a small fortune at every doctor’s visit and hated every second of it.

On the one hand, we were socking away money in our HSA, but on the other, we were paying thousands of dollars worth of medical bills.

It was a mental hurdle I had trouble overcoming. Sure we were setting aside money with every paycheck, but that money moved behind the scenes. While handing over my credit card at every doctor’s visit was very apparent.

My mind struggled to accept the idea that a high-deductible plan might save us money over the long haul. It might’ve been an issue of mind over matter, but with each medical bill, my logical brain lost the battle.

A Return to a Low-Deductible Health Plan

Two years ago, my husband’s employer introduced a traditional health plan with lower premiums than the high-deductible plan. It was the company’s way of attracting and hiring highly talented software engineers.

That November, we made the switch. There are downsides. I can’t stow money in my HSA or watch it grow, but I no longer feel guilty whenever my kids or I require a doctor’s visit. If we get sick, we go to the doctor without contemplating the financial impacts of that decision.

As a money nerd, I know that HSAs are magical bank accounts that allow us to invest tax-free. We can save pre-tax dollars, invest the lump sum, and cash out without ever paying taxes on the growth. I understand all these things and still feel confident in choosing the traditional plan.

I don’t want the fear of spending money to stop me from seeking medical guidance when I need it. I’m grateful for my husband’s health plan and realize it’s a blessing many other families don’t get to choose.

Unexpected Illnesses and Trips to Urgent Care

January is supposed to be the start of new things, but my plans for the new year didn’t happen quite the way I expected. Rather than feeling reinvigorated, I’m stuck in bed.

My youngest started coughing the day after Thanksgiving and didn’t stop for seven weeks! It began as an intermittent dry cough but quickly turned into a deep, mucusy, nearly non-stop hacking that kept us both up all night.

We went to the doctor two weeks after the coughing began. When his flu, COVID, and RSV tests came back negative, the doctor said to “give it a few more weeks.”

But two weeks later, his cough continued to get worse. We drove to urgent care late one Friday in search of answers, and they ran all the same tests and came to the same conclusions.

“Kids can cough for a while,” they told me. “If he’s not better in two weeks, follow up with his pediatrician.”

More Doctors Visits

And so we waited it out. We tried every cough medicine we could find, but none worked. We took my seven-year-old back in when the coughing began to sound like croup. Doctors ran the same sequence of tests and gave us a prescription for prednisone, which didn’t do a lick of good.

“It’s viral,” they told me again. So we went home without a prescription and waited to see if things improved. Each time we visited the doctor, they told us to return if his cough worsened.

On New Year’s Eve, he began coughing so hard he had trouble catching his breath. We found ourselves at another urgent care clinic a few hours after the calendar rolled into 2023.

“It’s possible a viral infection turned into a bacterial one,” the doctor said. I’m giving him an inhaler and a prescription for amoxicillin clavulanate. It was the fourth doctor’s visit in a month and a half. Two days after starting his medication, the cough began to dissipate. 

If we’d chosen a high-deductible plan at enrollment time, we would’ve spent $956. Instead of shelling out all that cash, we paid $60 for four $15 co-pays.

Pneumonia

A few days before Christmas, I caught the bug my son had raging inside him. A dry cough turned into a wet cough that kept me coughing so hard I couldn’t talk. Two weeks after the cough began, I went to the doctor’s office.

After checking for the flu, RSV, strep, and COVID, the doctor declared an unknown viral infection was most likely wreaking havoc and sent me on my way.

But one night, I checked my blood oxygen level and found it dropping below 90. A quick chest x-ray proved I probably had pneumonia. With our high-deductible plan, I would have paid $400 to $500 for that one visit.

Do High Deductible Plans Save You Money?

High-deductible plans make a lot of sense if you rarely get sick or require trips to the doctor. My husband seldom feels ill, so a high deductible plan makes perfect sense for him. He can save money on monthly premiums and rarely expect to pay high out-of-pocket expenses.

If he could choose a solo policy, enrolling in a high-deductible plan would be a no-brainer. But does it ever make sense for the rest of us?

Comparing the Cost of Medical Insurance

At enrollment time last November, I used the health plan comparison calculator at HSA bank to calculate which plan would save us more money.

In our case, it was a relative wash. Based on estimated doctor’s visits, co-pays, out-of-pocket maximums, deductibles, and co-insurance, we saved roughly $500 choosing a traditional plan. 

Of course, the calculator relies on guesses and estimations. A healthier year will always favor an HSA, while a year full of doctor’s appointments favors the traditional plan.

Choosing the traditional plan lets us go to the doctor without a second thought. That doesn’t mean we run to the doctor every time we feel a cold coming on, but it does mean I no longer hesitate to seek help when we need it.