A $5,800 deductible and no savings plan: How one teacher discovered the hidden cost of cheap health insurance

A teacher in San Diego enrolled her husband in a bronze-tier health plan with a $5,800 annual deductible, not realizing she’d have to pay that full amount before insurance covered most care. She didn’t understand how deductibles work—and didn’t know she could have opened a health savings account to help cover the cost.

Enhanced federal subsidies for health insurance expired at the end of 2025, pushing many people on the state and federal exchanges to choose high-deductible plans to keep monthly premiums low. Madison Burgess, a 31-year-old teacher, was one of them. She got insurance through her job but found adding her husband too expensive, so she shopped on the exchange. The plan she picked had a low monthly cost but came with a $5,800 deductible—money she’d have to pay out of pocket before coverage kicked in for most services.

She didn’t know that.

She also didn’t know she qualified for a health savings account. Enrollment in a bronze or catastrophic plan through the marketplace makes individuals eligible to open an HSA—a savings vehicle with a “triple tax advantage.” Contributions are made with pretax dollars, the money grows tax-free, and withdrawals for qualified medical expenses are tax-free. For 2026, the IRS allows up to $4,400 in contributions for individuals and $8,750 for families.

Even small monthly deposits can build a buffer. The money rolls over year after year and stays with the account holder, no matter job or insurance changes. It can pay for doctor visits, prescriptions, over-the-counter medicine, tampons, and sunscreen—just not monthly premiums.

Unlike flexible spending accounts, which expire annually and are tied to employers, HSAs are portable and permanent. Yet many people miss the opportunity, especially when cost pressures make setting aside money for health care feel impossible.

All marketplace plans cover preventive services like immunizations and cancer screenings at no cost, as long as the care is in-network. But beyond that, costs vary. Some telehealth visits cost less than in-person appointments. Some providers offer lower cash prices than insured rates—though those payments usually don’t count toward the deductible.

If a condition requires ongoing care, meeting the deductible early in the year can make the rest of the year cheaper. But if someone doesn’t expect to hit their deductible, paying cash might be smarter.

There’s another financial lever: income reporting. On ACA plans, failing to update income changes can lead to large tax bills. If earnings rise and aren’t reported, subsidies may be too generous—and the difference comes due at tax time. Contributing to an HSA reduces taxable income, which can help manage that risk.

One of the biggest problems, experts say, is people who get a job after signing up for subsidized coverage and never report it. Then they face a surprise bill they can’t pay.

The fix is simple: update your marketplace profile when income changes. And if you’re on a high-deductible plan, open an HSA—even if you start with $10 a month.