When shopping for health insurance, you probably noticed that different plans feature different deductibles. Understand what your health insurance deductible is as you maximize your health insurance coverage.
What Is a Health Insurance Deductible?
In basic terms, a deductible is the fixed amount you must pay toward your medical bills before your insurance coverage kicks in and begins to pay your expenses in full. Your specific deductible can be as low as $250 or as high as several thousand dollars and starts over again at zero on January 1 of each year.
How Does the Deductible Work?
Here is an example of how your deductible works using a $1,000 deductible amount.
- In February, you get the flu. You pay $200, the full amount, for the doctor visit and medication. Your deductible balance now totals $800.
- In May, you sprain your ankle. You total costs are $500 for the doctor visit, x-rays and brace. Your deductible balance is now $300.
- In August, you need a physical. You pay $300 for the doctor visit and blood work. Your deductible is now met. Any further doctor visits or health care needs that are covered by your insurance will be paid 100 percent.
What are the Different Types of Deductibles?
You can check your health insurance benefits package to see exactly what deductibles you may need to pay. Some common types include:
- Annual: It’s the amount of money you’ll pay annually from January 1 to December 31.
- Per Episode: Your deductible may vary based on the type of medical care you need. As an example, doctor visits may include a $25 deductible while hospital visits require a $1,000 deductible.
- Out-Of-Network: Visit a doctor, specialist or hospital that’s not in your network, and you’ll pay higher deductibles.
- Family: If you have family coverage, your deductible may be higher than the amount paid by individuals. When your family deductible is met, your insurance will pay your health care costs.
When Won’t You Pay a Deductible?
Some insurance plans allow you to receive three types of services and not pay a deductible. They include visits to an in-network doctor for preventative care, yearly screenings or your annual flu shot. Check your benefits package to verify that you won’t owe a deductible for these services.
What Services Don’t Count Toward the Deductible?
Even though you haven’t met your deductible, there are some health services you may need or want that don’t count toward meeting your deductible. These services are the ones your insurance won’t pay. Check your policy or call your agent for clarifications.
Your health insurance deductible is an important part of your medical care. Understand it as you maximize your health care coverage and take care of your health.