Affordable Care Act
What Is a Health Insurance Deductible?
Updated on November 15, 2019
Updated June 26, 2019
A deductible is a specific dollar amount your health insurance plan may require you to pay out of pocket toward covered medical care each year, before your health plan begins to pay for covered medical expenses.
Your annual deductible can vary significantly from one health insurance plan to another. Plans with higher metal levels (such as “gold” or “platinum” plans) tend to have lower annual deductible but higher monthly premiums. Plans assigned lower metal levels (like “bronze” plans) tend to have lower monthly premiums but higher annual deductibles.
The 2019 average deductibles for individual have dropped from 2018:
Many plans will pay for certain service – like a check-up, physical, or a disease management program – before you have met your yearly deductible.
All marketplace plans will pay the full cost of certain preventative benefits, as mandated by the Affordable Care Act.
Also, keep in mind that family plans typically have an individual deductible, which apply to each person, and a family deductible, which applies to the whole family.
Watch our video on deductibles
Review the infographic below for more information on deductibles
Be aware that copayments typically do not count towards your deductible, however they do typically count toward your out-of-pocket expenses.
Once you’ve reached your out-of-pocket maximum, your insurance will pick up the entire bill for any other covered care you receive in that year.
Is it possible to be insured with no deductible?
Yes, it is possible to get a health insurance plan with no deductible!
Some plans (typically HMOs) do not have a deductible at all. These plans are referred to as zero-deductible plans. Zero-deductible plans typically come with higher premiums while high-deductible plans typically come with lower premiums.
If you frequently visit doctors or take multiple medications, a zero-deductible plan may suit your budget and coverage needs
You can start shopping on eHealth and get free quotes for health insurance, including HMO plans.
High deductible plans and Health Savings Accounts (HSAs)
Plans with a high-deductible and low-premiums may appeal to individuals who are generally healthy, do not anticipate getting hurt, and do not visit the doctor often. While low-premiums may seem appealing to many health insurance shoppers, it is important to consider the amount of health care services you may need in the upcoming year both for yourself or any dependents you may have.If you do opt for a high-deductible plan you may be eligible for a Health Savings Account (HSA). An HSA allows both you and your employers to deposit a limited amount of pre-tax dollars into this account for medical expenses.
What does “no charge after deductible” mean?
This means that once you have paid your deductible for the year, the insurance company will kick in and pay 100% of the rest of your covered medical costs for the year. In this case, you will not have a copay or have to pay a coinsurance.
In most health insurance plans, the health insurance carrier (also called provider or company) usually only pays 100% of covered medical costs once you’ve reached your out-of-pocket maximum. This threshold is a similar idea to your deductible, except usually higher — meaning you have to spend more money on covered medical costs before reaching it.