An elementary school teacher chose a low-cost plan but later realized she didn’t understand what it would mean for her family’s finances.
“Once I got the insurance card, I compared our old plan to our new plan, and that’s when I really got worried, because I didn’t really understand what a deductible was. It got me thinking, how do I use this insurance?” — Madison Burgess, 31, San Diego
After enhanced federal subsidies ended at the close of 2025, many people buying coverage on the ACA exchanges saw monthly premiums rise and switched to high-deductible plans to save money. These plans lower monthly premiums but shift greater up-front costs to patients when care is needed. High-deductible coverage is common: in 2023, about 30% of people with employer coverage had a high-deductible plan, up from 4% in 2006.
Madison found a bronze exchange plan for her husband that looked inexpensive each month but carried a $5,800 deductible — meaning most services wouldn’t be covered until they’d paid that amount. If you’re in the same position, an HSA (health savings account) can help you prepare for those up-front costs.
Key terms
– Deductible: what you pay out of pocket before insurance shares costs.
– Premium: the monthly payment to keep your policy active.
1) You may qualify for an HSA without knowing it
If your plan is a bronze or catastrophic ACA plan (or another IRS-qualified high-deductible plan), you can probably open an HSA. HSAs let you contribute pretax dollars, the funds grow tax-free, and qualified medical withdrawals are tax-free — a “triple tax advantage.” You can use HSA funds for qualified expenses for yourself, your spouse, or dependents, including doctor visits, prescriptions, and many over-the-counter items. HSAs generally cannot be used to pay monthly premiums.
Unlike FSAs (flexible spending accounts), HSAs are individually owned, portable, and funds roll over year to year. If you change jobs or plans, the account stays with you.
2) How to open and fund an HSA
Open an HSA at a bank or other financial institution that offers HSAs; some employers require using a specific approved custodian. Many offer debit cards tied to the account. You can open an HSA anytime during the year as long as you’re covered by an eligible plan.
Contributions don’t have to be large — even small monthly deposits build a cushion. For 2026, IRS contribution limits are $4,400 for an individual and $8,750 for a family. Within those limits you choose how much to contribute.
3) Preventive care is usually free in-network
Marketplace plans must cover certain preventive services at no cost when delivered in-network. That includes routine immunizations and screenings. Beyond that, costs vary: telehealth visits can be cheaper than in-person primary care visits depending on the plan. Review your plan’s summary of benefits to compare costs for different kinds of care.
4) Consider timing: seek care early in the year when possible
Most deductibles reset on Jan. 1. If you discover a condition that will require ongoing care, scheduling needed appointments or procedures early in the year can let you meet the deductible sooner so insurance helps for the remainder of the year. If you can afford it, paying to meet the deductible early can reduce total annual spending.
5) Sometimes paying cash makes sense — but know the tradeoffs
Some providers offer lower self-pay prices than what you’d pay in-network through insurance. You have the right to request an itemized good-faith estimate before care; compare that cash price to the insured cost. If you elect to pay cash at the time of service, you generally must do so before charges are submitted to insurance. Note: cash payments usually do not count toward your deductible or out-of-pocket maximum, so compare carefully.
6) If you get subsidies through the ACA, keep your income current and use HSAs to lower taxable income
If you receive marketplace premium subsidies, report income changes (raises, new jobs, side gigs) promptly. Failing to update your marketplace application can create a large reconciliation bill at tax time if your income was higher than estimated. Because HSA contributions reduce your taxable income, contributing to an HSA can help mitigate the tax impact of increased earnings.
Practical tips
– Read your plan’s summary of benefits and provider network before you need care.
– Open an HSA early and contribute what you can; even small amounts add up.
– Ask providers for a cash price estimate and compare to your in-network cost.
– Schedule predictable or ongoing care early in the year if feasible.
– Update your marketplace income whenever it changes to avoid subsidy repayment surprises.
Many people choose high-deductible plans to save on premiums but are surprised by how much they might owe when they need care. An HSA, careful planning, and clear communication with providers and the marketplace can make a high-deductible plan work better for your budget and health needs.