Guides

Deductibles

Every health insurance plan mentions a deductible. But what, exactly, is a deductible? A deductible is an out-of-pocket payment toward your health insurance claim, and after hitting that amount, your insurance splits costs with you. For instance, if you have a $2000 deductible, you must pay $2000 before your health insurance benefits kick in. It’s essentially the amount you must pay before your health insurance starts paying benefits, but that does not mean that you always must pay a deductible.

Some plans are a $0 deductible, meaning that you don’t pay any deductible before your benefits kick in. This is not the same as co-pay. These plans usually have a higher monthly premium. All ACA-compliant Marketplace plans must cover the full cost of certain preventive benefits before you’ve met your deductible. This is mandated due to the Affordable Care Act and includes things like annual physicals, vaccines, and other screenings.

Every year your deductible starts over again and some plans (namely family plans) may have multiple deductibles (individual and family) and it’s important to note that you pay 100% of whatever your deductible amount is. Once you have paid the full deductible your insurance company will take care of the rest of the costs. Deductible payments go straight to the provider’s office or hospital giving you the medical care — not to the insurance company.