Oct. 5, 2020
Understand Your Health Plan's Deductible
The deductible is the amount you pay before your insurance company starts payingÌýitsÌýshare of the cost ofÌýhealthÌýcareÌýservices you receive. Even with insurance, you pay the full cost of services until you meet your plan’s deductible.ÌýAn exception that applies to most plans are preventive services;Ìýmost plans provideÌýcertain screenings and vaccinesÌýat no cost to you, whether you’ve met your deductible or not.ÌýÌý
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THINGS YOU SHOULD KNOWÌý
You must payÌýall ofÌýthe costs up to theÌýdeductibleÌýamount beforeÌýaÌýplan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, butÌýnotÌýalways, Jan. 1).Ìý
Most plans with lower premiumsÌý(theÌýfixed amount that you pay each monthÌýto be a memberÌýofÌýyourÌýhealth plan)Ìýhave higher deductibles.ÌýWith a lower premium plan, you’ll pay less up front, but you may end up paying more in total if you needÌýa lot of health care services in a year.ÌýSome plans countÌýcosts for medical services toward one deductibleÌýand costs forÌýprescription drugs toward a separate deductible.ÌýÌý
Co-insuranceÌýis the percentage you pay for most health careÌýservicesÌýeven after you meet your deductible.ÌýFor example, if your coinsuranceÌýfor a serviceÌýis 20%, then the insurance company pays 80% of the covered amount and you pay 20%Ìýfor each service.ÌýCopaysÌýare dollar amounts you pay for each service,Ìýinstead ofÌýa percentage of the service cost.Ìý
TOP CONSIDERATIONSÌý
Check your health plan’s website.ÌýMost health insurers have websites you can use to access the most up-to-date information about your plan. You can learn what your plan covers, what doctors and facilities (e.g., hospitals and labs) are in your plan’s network, what prescription drugs the plan covers, what claims the plan has paid and how much of your deductible you still need to meetÌýfor the year. You usually need to register or create an account to log in to get informationÌýspecific toÌýyour health plan.Ìý
Check the Summary of Benefits and Coverage (SBC).ÌýWhether you’re shopping for a new plan or already enrolled,ÌýaskÌýtheÌýinsurance company orÌýyourÌýemployer forÌýanÌýSBC. This is a short list of your benefits and deductibles, copays and coinsuranceÌýamounts.ÌýÌý
If family members are covered under your health plan, thereÌýmayÌýbe two deductibles.ÌýAll ofÌýthe costs for services for each individual in the plan count towardÌýan individual deductible, while all of the costs for everyone in the familyÌýadded togetherÌýcount toward the family deductible.ÌýIn most plans,ÌýonceÌýyou’ve met the family deductible, you’ve also metÌýallÌýindividual deductibles.ÌýÌý
Your plan may pay all the costs for preventative services even before you meet your deductible.ÌýCheck with yourÌýprovider and your plan to make sure your service is considered preventive.Ìý
TOP THREE THINGS TO REMEMBERÌý
- Paying a premium doesn’t mean yourÌýhealth insuranceÌýplan will pay for all your health care costs. You’ll have to pay the full cost of most services until you meet your deductibleÌýand any co-insurance until you reachÌýthe out-of-pocket maximum.Ìý
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Lower deductibles often mean higher premiums for a health plan. Consider how likely you are to use health care services when you choose a plan. For some people,Ìýit may make senseÌýto pay a higher premiumÌýto get a lower deductible.Ìý
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The ²»Á¼Ñо¿Ëù¹Ù·½ has tools to help you understand your health plan. Read ourÌýconsumerÌýguide toÌýUsing Your Health Plan,Ìýand visit ourÌýconsumer health pageÌýfor more information.Ìý
About the National Association of Insurance Commissioners
As part of our state-based system of insurance regulation in the United States, the National Association of Insurance Commissioners (²»Á¼Ñо¿Ëù¹Ù·½) provides expertise, data, and analysis for insurance commissioners to effectively regulate the industry and protect consumers. The U.S. standard-setting organization is governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the ²»Á¼Ñо¿Ëù¹Ù·½, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. ²»Á¼Ñо¿Ëù¹Ù·½ staff supports these efforts and represents the collective views of state regulators domestically and internationally.