So you thought those $20 doctor's office co-pays and your $250 deductible threw you off budget fast? That was nothing.

Get ready for the world of consumer-directed healthcare, where you'll pay $1,050 to $5,450 out of pocket before the insurance company pays anything.

General Motors Corp., Chrysler Group, Ford Motor Co. and most of the large auto suppliers are among those companies that now offer high-deductible plans paired with health savings accounts — HSAs — as an option to their workers.

"If you don't know about HSAs now, you damn well better," said Dr. Joe Fortuna, co-chairman of the Health Focus Group for Southfield, Mich.,-based automotive trade organization AIAG. "HSAs are going to be the most prominent employer-offered health plan option in five to 10 years."

Why? Because the premiums for traditional health insurance keep going up, and by using HSA-linked plans, employers can more precisely budget what their health tabs will be.

The concept is growing in popularity as employers from GM to Starbucks report they spend more on healthcare than they do on their main components, be it steel or coffee beans.

Nationwide, 3.2 million Americans — from corporate employees to the self-employed — have enrolled in the high-deductible health plans, up from 1 million just a year ago, reports America's Health Insurance Plans.

With traditional insurance plans, employers are basically giving employees credit cards and paying the bill for them at the end of the month, said Kate Kohn-Parrott, director of integrated healthcare and disability for the Chrysler Group.

With HSA-linked plans, workers are responsible for the first several thousand dollars of expenses, which makes monthly premiums much lower than with traditional plans, in which insurance companies pay a share of every doctor's office visit or trip to the emergency room.

The result is that employees will foot more of their own healthcare tab and are responsible for saving to be able to do that.

Critics say the plans are just another tax-sheltering tool for the healthy and wealthy and are worried it will result in those who aren't wealthy putting off preventive care and ending up in dire straits when they haven't saved enough to pay for unexpected medical needs.

The U.S. Treasury Department projects that 7 million to 21 million Americans will have HSAs in four years.

In most cases, the employee is responsible for building up savings in the tax-free HSA. But at Chrysler and some other companies, the employers also are contributing to the accounts. Employees then can use the HSA to pay for medical expenses they incur while they're paying their out-of-pocket expenses before insurance coverage kicks in.

Dean Thurman, 38, is a financial planner and senior partner at Financial Independence in Bloomfield Hills, Mich. He signed up for an HSA-linked health plan as soon as the federal government signed them into law.

"It cut the premium in half and gave me all the coverage I had before, plus a tax deduction," said Thurman, who lives in Clarkston, Mich., with his wife and two children, ages 10 and 8. "The problem with HSAs is you have to be in decent health to get them, and they have the higher deductible."