Hi Deductible insurance + HSA = what am I missing?

It absolutely *is* that simple.

Go for it, and don't look back.  Most HSA "savings" plans are also investment plans that can grow tax-free.

Only thing I would investigate for you is whether the deductible includes all visits whether it's at a clinic, ER, staying in the hospital, etc.  I know with Medicare that hospitalization coverage is a totally different set of coverages and deductibles from other types of care.  Since being in the hospital is SO expensive, it's worth verifying.

It can be pretty simple.  I'm attaching a graph from the spreadsheet I put together to analyze the insurance plans offered by my company.  Horizontal axis is the medical expense, vertical axis is total cost to an individual (in this case) on the various plans.  If you'd like the spreadsheet, I can send it via e-mail.  HC80 is a traditional 80/20 insurance plan while the CH80/90 are high-deductible plans.  I haven't included the impact of income taxes on the analysis.  

I've done plots like this for over 20 years (since my first employer offered a cafeteria plan) and they haven't really changed a lot in that time.  There is very little difference in the cost for low expenses (less than $2000/year) or high expenses (over $20,000/year) even though the plans sound like they will be very different.  In effect, the more "comprehensive" health insurance plan functions more like prepaid healthcare.  

In my experience you get the negotiated rates because you're still giving them your insurance card like normal and they process it as insurance.  However, if your deductible for the year hasn't been met your "co-pay" is the full amount owed.

Chris, in my experience the HSA has always been a better plan for our family.  It's a little weird paying everything out of pocket, but when you compare the savings, it generally works out to your benefit.

Depending on your tax bracket and current investments the HSA account can be used as another tax free investment vehicle.  I believe the 2014 family contribution can be up to $6550 for the year tax free.  You can put the money into mutual funds just like an IRA where it grows tax free.

This.  That's what worried me a little.  I know the copay going in, I don't know the usual and customary

Honestly, I took a closer look at my medical history the lat 4-5 years, and went with the lo deductible.  I've had a few things pop up and have hit my max out of pocket a couple times.... and have ongoing meds.  So going the "safe" route.   May be a mistake, but moving on

I made the mistake several years ago of just "paying" for stuff with my HSA card and walking away.  I was paying the full price and my insurance wasn't even aware of my spending.  So when I hit several thousand dollars I went to their website and showed that I had paid zero towards my deductible and I called them to find out how I prove what I've been spending.  They informed me that I still have them submit everything to my insurance like normal and they run it through to get the reduced amount and I either pay it there or they send me a bill showing my portion and the insurances portion.  I had a /facepalm moment.

Doing it the proper way now on most of our regular doctor visits, they just run it through insurance like normal and send us a bill at the discounted prices.  We then get full credit towards our deductible.

I have a prescription that normally costs $180/mo. (street price, no insurance) that I get for $120 when I run it through insurance before my deductible is met.  When our family deductible is met, I just give them my insurance card and the pharmacy just charges me $30 (or whatever it is) for the 20% portion because the insurance responds back with what my "copay" is.

It works pretty slick as long as you run everything through the insurance from the start.  If you just pay for stuff without giving your insurance info it's a royal pain because you're sending in forms to get credit and also get stuck with the higher prices.

Ironically, I learned in this process that the generic med I've been paying a $15 co pay for at CVS for a $27 scrip can be bought without insurance at costco pharmacy (with delivery) for $5......  So there's a hundred twenty a year I am saving at least 

I've been on a high deductible plan for years - I have built the spreadsheet and modeled the costs.  It does work for me, and I have asthma (which has a slew of pretty pricey maintenance drugs) as well as terrible luck and at least one ER visit or surgery per year.  BUT the math only works because a) my employer loads my HSA for me (so free $1500 towards those drugs every year) and b) my husband has almost zero medical costs.  I like high deductible because it does what insurance is SUPPOSED to do - protect you when things get really bad - you don't get to go to the doc for every stupid little cold because it costs you, but when you end up in the hospital, you will not end up bankrupt.