A $5,800 deductible and no safety net: How a teacher’s cheap health plan left her unprepared for medical costs

A teacher in San Diego faces a $5,800 out-of-pocket bill before her husband’s health insurance will cover most medical care — a consequence she didn’t anticipate when choosing a low-cost bronze plan on the ACA marketplace.

Enhanced federal subsidies that had lowered premiums on exchange plans expired at the end of 2025, pushing many consumers to cut costs by switching to high-deductible health plans. Madison Burgess, a schoolteacher, selected a bronze-tier plan for her husband after finding her employer-sponsored coverage too expensive to extend. She didn’t understand that the plan’s $5,800 individual deductible meant they would pay nearly all medical costs upfront.

She also didn’t know she qualified for a health savings account. Enrollees in bronze and catastrophic plans are eligible to open HSAs, which allow pretax contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses — a combination known as the “triple tax advantage.”

The IRS sets annual HSA contribution limits: $4,400 for individuals and $8,750 for families in 2026. Contributions can be as small as a few dollars a month, but the accounts must be opened while enrolled in an eligible plan.

Unlike flexible spending accounts, HSA funds roll over indefinitely and remain the account holder’s property, even after changing jobs or plans. The money can pay for doctor visits, prescriptions, and over-the-counter items like sunscreen and tampons — though not monthly premiums.

For consumers who don’t expect to meet their deductible, paying cash for services may be cheaper. Some providers offer lower rates for upfront payment, though those amounts don’t count toward the deductible or out-of-pocket maximum.

But if income rises during the year and is not reported to the marketplace, consumers risk a large tax bill when reconciling subsidies. Stashing money in an HSA reduces taxable income, which can ease that burden.

Burgess now faces potential financial strain if her husband requires care before meeting the $5,800 deductible.