What happens when you meet your deductible?

Key takeaways

• After you meet your health insurance deductible, your plan starts paying more of your medical bills. But you’ll likely still pay something, like a fee per visit (copay) or a percentage of the cost (coinsurance), until you hit your out-of-pocket limit.
  • Example: If your deductible is $2,000 and you’ve already paid that much for care, your plan may start paying most of your future medical costs. You might still pay a $20–$25 copay at the doctor’s office or 20% of each bill, depending on your plan.
• There are different types of deductibles, and the amount you need to pay (or your share of the cost) depends on the plan. For example, some plans have a high deductible, where you pay more before insurance helps but your monthly cost is lower. Others have a low deductible, where insurance helps sooner but your monthly cost is higher. There are also individual and family deductibles, and some plans have separate deductibles for things like prescriptions or out-of-network care.
• Knowing how your deductible works with other costs like copays, coinsurance, and your out-of-pocket limit can help you avoid surprise medical bills. For example: If you keep track of what you’ve already paid, you can decide the best time to get medical care throughout the year by knowing when your insurance will start paying more. This is especially useful if you have specific or ongoing treatments, doctor visits, or surgeries to plan in advance.

Now let’s go more in-depth about what deductibles are, how they work, costs that typically count towards your deductible, and smart steps to take after meeting yours for the year.

Closer look: What is a deductible?

A deductible is the amount of money you have to pay each year for certain medical services or expenses before your health insurance starts helping with the cost.

• Every health plan is different, so your deductible amount can be high or low.
• Things like lab tests, X-rays, hospital visits, and procedures usually count toward your deductible.
• Other costs — like your monthly premium or the copay required to see a doctor — usually do not count toward your deductible.
• Your deductible resets each year on the anniversary of your plan start date — bringing you back to $0 for the amount you’ve paid towards your deductible.

Types of deductibles

Now let’s look at the different types of deductibles and which may be best suited for you or your family.

Individual vs. Family Deductible

Type of Deductible:	Who it’s for:	How it works:
Individual	One person	You pay all costs for covered, qualifying medical services until you meet your deductible; afterward, your plan begins sharing the costs.
Family	Whole family	All family members’ costs count toward a single family total. Once met, the plan covers everyone. Different types of family deductibles are explained in the next chart.

Type of Family Deductibles

Type of Deductible:	What it means:	Example:
Aggregate	One large deductible for the whole family	Everyone’s costs accumulate; once the total is met, the plan covers the entire family.
Embedded	Each person has their own deductible, plus a family maximum amount.	Once a person meets their deductible, the plan begins to cover them—even if the family deductible isn’t met. When the family deductible is reached, it covers everyone.

High vs. Low Deductible Health Plans (For Individuals and Families)

	High Deductible Plan (HDHP)	Low Deductible Plan
Who it’s best for:	Generally healthy individuals or families who don’t visit the doctor often	People or families who need regular medical care or want predictable costs
Deductible amount:	Higher deductible before insurance helps pay	Lower deductible, insurance helps sooner
Monthly premiums:	Lower monthly payments	Higher monthly payments
Out-of-pocket costs:	Higher costs before deductible is met	Lower costs before deductible is met
Health Savings Account (HSA) eligibility:	Yes, allows tax-free savings for medical expenses	Usually, no HSA option
Best if you:	Want lower premiums and can pay more if you need care	Prefer to pay more each month but less when you get care
Family or individual plans available:	Both available	Both available

Since every deductible plan is different, picking the right one for you or your family will depend on your specific single or collective healthcare needs and how much you wish to spend on overall health insurance coverage.

What counts toward your deductible?

While moving towards meeting your deductible, it’s important to realize that not every healthcare cost helps you get there. Look at the chart below for some examples of what typically counts and doesn’t.

Costs that typically count toward your deductible:	Costs that typically don’t count:
Bills for hospitalization – Charges from a hospital stay, including room and facility fees.	Copays – Fixed amounts you pay for services like doctor visits or prescriptions.
Surgery – The cost of inpatient or outpatient surgical procedures.	Premiums – Your monthly insurance payment does not count toward your deductible.
Lab tests – Bloodwork, urinalysis, and other diagnostic tests ordered by your doctor.	Any costs your plan doesn’t cover—such as excluded services (e.g., cosmetic procedures) or out-of-network charges if not permitted.
MRIs and CAT scans – Advanced imaging services used to diagnose conditions.
Anesthesia – The cost of sedation or pain management during procedures.
Doctor and therapist visits not covered by a copay – These visits are billed directly if they aren’t part of your copay structure.
Medical devices such as pacemakers – Medically necessary equipment and implants often count if covered by your plan.
Prescription medications (sometimes) – Some plans count drug costs toward the deductible, especially if you have a combined medical and drug deductible, while others keep them separate. Check your plan details to make sure.

Pro Tip: Preventive services — like annual checkups, vaccinations, and certain screenings— usually don’t count toward your deductible because they’re often free under most health plans when done in-network.

Smart steps to take after meeting your deductible

If and when you’ve met your deductible for the year, it can be a great time to take care of important health needs before your deductible resets at the start of your next plan year.

Steps to consider:

• Schedule postponed care:
  If you’ve been holding off on procedures, specialist visits, or follow-ups due to cost, now may be the most affordable time to get them done.
• Refill prescriptions or explore 90-day supplies:
  If your coinsurance is lower or waived, refilling necessary medications now could save you money — especially if your plan offers a bulk supply option.
• Book preventive care screenings or annual checkups:
  These are often free regardless of your deductible, but if there are follow-up tests or treatments, you may now pay less.
• Plan ahead for any needed imaging or outpatient procedures:
  Services like MRIs, physical therapy, or outpatient surgery could cost significantly less once your deductible is met.
• Track your out-of-pocket max:
  If you’re close to hitting your out-of-pocket maximum, most of your remaining care for the year may be fully covered, so make sure to keep track of your expenses.

Summary: What to do when you meet your deductible

Meeting your deductible is a big step. It means your plan will now help pay more of your health care costs. This could be a good time to schedule treatments, tests, or refill prescriptions while your costs are lower.

Use in-network providers, check your coverage details, and track how close you are to your out-of-pocket maximum to make the most of your benefits and save money.

FAQs about what happens when you meet your deductible

Now let’s look at some of the most frequently asked questions about deductibles and meeting yours over the course of your health insurance calendar year.

How long does it take to meet your deductible?

The length of time to pay your deductible for insurance will vary based on the amount of your deductible and how much you spend at a doctor’s visit, among other factors. For example, if your deductible is $1,000, it might take you several months’ worth of doctor’s visits and tests to meet your deductible. However, you might meet this deductible in a single day or week if you are involved in an accident and hospitalized.

What if I don’t meet my deductible?

If you do not meet the deductible in your plan, your insurance will not pay for your medical expenses — specifically those that are subject to the deductible — until your deductible is reached. For instance, if your deductible is $2,000 and you have an ER visit that costs $700, insurance will not pay anything towards that amount until you’ve paid $2,000 in qualifying medical costs.

What do I pay after your deductible is met?

After your deductible is met, you may still need to pay other fees such as co-payments. For instance, if your doctor has a co-payment of $30 per doctor visit, you will still need to pay this co-payment even after your deductible for insurance is met. You will also need to pay for medical services if you use a provider or specialist outside of your network, if it isn’t allowed on your plan.

How does a family plan deductible differ from an individual plan deductible?

Many family health insurance plans include individual deductibles for each family member along with a family deductible to meet as a group. The family deductible can vary depending on the plan chosen but is typically larger than the amount of an individual deductible (often by 2 to 2.5 times more). When a covered member of a family meets their individual deductible, that money also applies to the family deductible.