My Coverage Explained

What is a CDHP and How Does It Work?

 Buying health insurance can be very confusing, and we all want to choose the best plans for our needs. Here’s a closer look at the consumer-directed health plan also referred to as a consumer-driven health plan (CDHP), and sometimes called a high deductible health plan (HDHP). The way it works out is that a CDHP is a kind of HDHP. There are other HDHPs out there. I know. More things to choose from, so how is a CDHP different from all the other plans out there? We’ll tell you everything you need to know about a CDHP and you can decide whether it’s right for you.

With a consumer-driven, or consumer-directed health plan (CDHP), you must pay your medical costs before your health plan does. Costs are shared from the time coverage starts with other health plans such as a Preferred Provider Organization (PPO) or a Health Maintenance Organization (HMO).

Here’s an example. With a PPO and an HMO, you typically have a copay when you visit a doctor. Extra covered medical costs that occur from that doctor visit, would be covered by your health plan. With a CDHP, you must pay medical costs up front to reach your deductible amount before the health plan starts paying its part of covered medical expenses.

If your average year involves you visiting a doctor for your well woman exam or annual wellness exam and perhaps a seasonal cold, a CDHP may be economical for you over the course of the year. A CDHP is a health insurance plan with a high deductible. That means you pay a higher amount out of pocket before your insurance starts paying. While that may not be attractive to some people, some members with a CDHP pay lower monthly premiums to have the plan than they do with a PPO.

What you get with a CDHP?
CDHPs are designed to encourage consumers to become actively involved in their health care decisions. Here are a few:

  1. Make cost-effective health care decisions according to your budgets (e.g., designing your health insurance coverage.
  2. Select health services and managing your own fitness and wellness.
  3. Choose your health care provider.
  4. Get access to a tax-friendly account to help pay your expenses.

What is an HSA and what do you get with it?
High-deductible health coverage often pairs with having a Health Savings Account (HSA) or health reimbursement account (HRA) that can be used to help meet the deductible. With an HSA you:

  1. Get a pre-tax account that you contribute to and the money can only be used to pay for qualified medical expenses, which are set by the Internal Revenue Service (IRS) every year.
  2. In addition to contributing to the accounts before taxes, you also earn interest, the money never expires and you can take it with you even if you change jobs.
  3. Your employer probably contributes to both of these kinds of savings accounts making it cheaper for you.
  4. Get reimbursement for qualified, out-of-pocket medical expenses.

When you and your employer contribute to either of these accounts, it’s an incentive to get you more involved and aware of the money you spend on your health care services from doctor visits, to medical tests and prescription drugs. Studies at BCBSIL show that people who have switched from traditional plans to CDHPs are four percent more likely to use preventive services, like an annual well woman exam or annual physical with a primary care physician. These preventive services proved to lower follow-up costs due to late discovery of health related issues.

With a CDHP, you have a large set of medical and professional services that are in your network. It’s often the same broad network of doctors available in a PPO. Because all networks are NOT the same, it’s important to make sure all your doctors and services are in your network to save you money. You can still use out-of-network providers with a CDHP, but it will cost extra. Always use BCBSIL’s Provider Finder to make sure your doctor is in network. Be sure to call the number on your member ID card to reach your Benefit Value Advisor to help you find the lowest cost provider for any MRIs or CT scans.

Remember these advantages to having a CDHP:

  • Your plan comes with a pre-tax savings account dedicated to qualified medical expenses that you can contribute as much or as little as you like to.
  • Your HSA or HRA earns interest, never expires and goes with you wherever you go.
  • Studies show your spending on health care goes down.
  • You take a more active part in your health care decisions.
  • You have lower monthly premiums.
  • You getaccess to a broad network of providers (doctors, hospitals, testing facilities).

If you decide the network of doctors and the price are right for you, you may choose to buy a CDHP during the next open enrollment period. Once you’re a member, you can log on to your personal account in Blue Access for Members (BAM). There you will find a place to ask all your health insurance questions regarding your plan, and someone will reach out to you with answers.

Choosing the right health insurance coverage is a big decision and it’s important to make the right choices for you and your family. Hopefully this helps offer you guidance. If you still have questions about your health plan, PPOs, HMOs, IROs, etc., leave a comment!

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