Who could afford a higher annual deductible who couldn't afford a higher monthly payment?
Your title question, Who could afford a higher premium who couldn't afford a higher monthly payment?, contrasts premium with monthly payment, but those are the same thing.  In the body of your question, you list monthly payment and deductible, which is entirely different. The deductible is paid only if you need that much medical care in any one year.  Most years a person in good health pays little because of the deductible.  Thus, the higher deductible options offer catastrophic health insurance without giving much in the way of reimbursement for regular medical expenses. Note - the original question has been edited since. It's simple. Most people don't spend $6000 a year in medical care. As for myself, there's probably only $400 or less, mostly in annual checkups and the like.  If you are the type to require more medical care, then you will pay more per month. I know a person with asthma, kidney stones, and inflammatory issues. This person spends probably $1000 in co-pays per year, with considerable more if you were to include the hospital visits in the likes. But if you don't think you are one of these people, then don't get the higher cost plan. I edited in the total annual out of pocket for each level to help illustrate what's going on. Your question makes sense, of course, but it's less a matter of afford vs an attempt to save. The way these plans work is to allow some choice based on your past experience. I can afford any option, but knowing the number of visits we have had in the past, the lowest cost option has the highest premium. A young couple who hardly sees a doctor may choose the highest deductible, risking the potential $3434 extra they may pay in a bad year for the savings of $1016.  Personally, I'd not be able to guess accurately enough to benefit from the middle choices, and can see the two extremes being picked most often.
And this tells me you have little to no understanding. I have LIVED this life, I am black, from an inner city, my father is a deadbeat and my mother was diagnosed with MS, leaving her disabled until she died before I graduated from high school. My grandmother raised me while trying to care for a daughter that couldn't walk and another daughter struck blind by disease. Without public assistance, I wouldn't have been healthy enough to get a scholarship to a very expensive boarding high school, and really isolate myself from the shit around me. i have cousins who died living the gangster bullshit life, I know this world from seeing it. I make a fairly decent amount of money now, why, because when I couldn't find a job, I could still eat on food stamps and go to a free program to qualify for the government to pay for my IT certification. So, seeing as I KNOW how the system can be used to get to a better place, make a goddamn argument that your idea works better, not how you feel things should be. I make me decisions based on what I've seen, I have known women shafted by circumstance struggling to be able to work because they need a specific number of hours to ensure they can have child care so they can work at all. I have tutored adults that never graduated high school because they had to drop out and work years ago to help their families afford to live. I have used medicaid to help with my horrible episodes of depression, gotten treatment my family alone could not afford. I have watched my aunt recover from drug addiction using treatment my family could not afford. My grandmother is alive and still helping the down and out in our family due to medical equipment the family could not afford on its own. I do base my decisions on evidence, I have lived the fucking evidence. It is much simpler than any of that.  People who make money have a greater capacity to pay their bills.  Credit card companies make money off of people who can afford to pay several hundred dollars a month in interest charges.  If you only make 500 a month you can not afford to pay 200 in interest.  So their cost of doing business with you is higher.  These cards are issued to make money.  And they make their money off of people paying 12-29% interest on their 5k+ credit limits they have nearly maxed. "You can't get a HELOC, to the best of my knowledge, without actually ""owning"" the house. If you get an 80% mortgage (of the purchase price - not the appraised value, btw), you still need 20% as a down payment. Once you own the home, you can apply for a HELOC ... presuming you have enough equity (eg, the purchase price is $40k less than the appraised value). We haven't looked at the norm, at least where I live, of 5% down for a traditional mortgage and 3.5% for an FHA (which your question touches on). If you can do 5% down, on a $1,000,000 mortgage you need $50,000 on the day of closing. If the home is worth (ie appraises for) $1,250,000, you're getting 20% of the house ""for free"". Presuming the bank(s) will go for it, you could likely then open a HELOC for as much as $250,000 (again, depending on individual lender rules). tl;dr: If you don't have the money ready on the day of signing (via seasoning, if it is a loan/gift, or because you have been saving), you cannot afford the house. To clarify from comments with the OP, I am in no way speaking to the buyer's ability to afford the monthly payments - this is only about affording the initial costs associated with the home buying process (down payment, closing, whatever else the bank(s) require, etc)." If (and only if) there is a zero interest installment plan available, technically the only uncontrollable risk is that there will likely be a hard inquiry on your credit report which may or may not also have a corresponding debt obligation attached to it. (Personally, I recently signed up for one such plan with Google and I had a hard inquiry but no debt added to my report). The other risks are that 1) your monthly payment goes up, so if you are living on a tight budget the added payment might make it harder to meet your next bill, and 2) you could miss a payment which generally triggers interest to accrue retroactively at a high rate, and in some cases could be grounds for immediate repayment. The pro / reward of these plans is that you have to spend less of your capital upfront, which you may be able to use for other purposes (presumably with a higher net present value than purchasing the item you're considering outright). A larger example would be purchasing a new car. You want to buy a $50k car and you have the cash on hand to pay in full, but you are being offered 0% interest for 36 months. You may be more inclined to take a loan at 0% with 0 down payment and invest your money in another vehicle (no pun intended) that offers you a decent rate of return and you will come out ahead in the end. Of course, this example works in a perfect world where you can get such an offer, there are no extra fees available, you aren't worrying about your debt-to-income ratio in preparation for a big purchase like a house, there isn't a higher insurance premium to consider, etc. In short, 0% financing, be it for a phone or a car, can be a nice perk for the informed consumer who is not using the financing as a way to purchase outside their financial means, but it is offered by companies as a way to make people buy things they normally would not and, hopefully, capitalize on people missing payments in order to reap the sweet 20%+ interest rates generally seen with these offers.  In your specific situation with the phone, you should consider if you get a discount on your monthly plan for purchasing outright, or if you can get the phone subsidized if you sign a contract (and you know you like your provider enough to stay for its duration). If the monthly plan rate stays the same and you're looking at either $500 now or $500 over 24 months and you don't mind a hard inquiry, there's not much of compelling reason to pass on the financing and hold on to your $500. I'm talking about household income. $300k is a huge amount of money for a single person to make, but $150k is certainly doable for most doctors/lawyers/engineers. If your spouse is also a high earner that will help put over the 1% threshold. Let's say I have two loans (say 2 car loans), and the high interest loan has a higher balance.  Both have a monthly payment of, say, $500. My income fluctuates a lot, so occasionally I only have $750.  I get hit with big fees those months, or maybe I just have to eat beans for those months.  I come on some extra money.  Maybe enough to get rid of the low interest small loan. Paying off the smaller loan frees up cash.  I don't have to eat beans on the bad months. HSA rules are different in some regards than deductions allowable under Pub 502 which deals with medical expenses deductible in Schedule A of your tax return. Pub 969 governs HSA's and similar reimbursement plans, and the guidelines are as follows: Insurance premiums. You can’t treat insurance premiums as qualified medical expenses unless the premiums are for: -Long-term care insurance. -Health care continuation coverage (such as coverage under COBRA). -Health care coverage while receiving unemployment compensation under federal or state law. -Medicare and other health care coverage if you were 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap). Since your wife is still being treated like an employee for health benefits, and you are not on COBRA, thus not eligible for a deduction. You may qualify under the unemployment provision depending on the cause of her disability. My guess would be a black American express. Or, the accountants will make them switch out throughout the year to get maximum benefits. Sometimes, 1% maxes out at a certain amount, so they'll use a different CC every quarter or so.