Most health plans have an annual deductible: the amount you are responsible for paying before your insurance begins to cover you. if you’re lucky, you’ll have a very low deductible, or even no deductible at all.
In many ways, the deductible is what stands between you and the full benefits of your health insurance. it’s like the first hurdle you have to clear before your health plan starts paying you back for the premiums you paid. therefore, managing your deductible is key to understanding your plan and saving money.
If you’re one of the many people who find it difficult to keep track of your deductible, you can try one of the new online services, like simplee or cake health, that are designed to make taking advantage of it that much easier. In this post, we’ll explain what a health insurance deductible is, what you need to know about them, and more. use the links below to jump to the section that best answers your query, or read on for a more detailed overview on the topic.
- what is a health insurance deductible?
- How do deductibles work?
- sample health insurance deductible
- essential things to know about your annual deductible
- choose the correct deductible amount
what is the health insurance deductible?
Health Insurance Deductible Definition: healthcare.gov defines a health insurance deductible as the minimum balance you pay before your insurance company begins to cover medical costs.
If your deductible is $2,500 and your doctor visit costs $5,000, for example, you’ll be responsible for the $2,500 portion. In other words, you’re responsible for paying a certain amount of your medical expenses yourself, and your insurance company will start covering the costs only after you’ve paid that deductible.
how do deductibles work?
Once you’ve met your deductible, your provider will usually only ask you to cover part of it through a copay or coinsurance, while they take care of the rest. Keep in mind that every insurance plan is different, so it’s important that you not only understand how deductibles work, but also how they fit specifically into your plan.
Certain insurance plans will cover services such as checkups or preventive care even before you meet your deductible, so make sure you know the details of your plan before you do or don’t seek medical care.
health insurance deductible example
Let’s look at an example of how deductibles work to get a clearer understanding:
Let’s say you have a health insurance plan with a $700 deductible. one day, you require a medical procedure that costs $7,000, which is covered in your plan. your health insurance provider will help pay these costs, but only after you’ve met your $700 deductible. this is what happens next:
- you pay your $700 deductible out of pocket to the provider
- then, after you meet the deductible, your health insurance plan begins to cover the remaining balance of $6,300
- Depending on your plan’s copayment or coinsurance policies, you may have to pay a percentage of these costs
high deductible plans vs. low deductible plans
- high deductible health plans
- what is a high deductible health plan (hdhp)? HDHPs have higher deductible rates than most insurance policies, but they do offer some flexibility and tax advantages that may be helpful for some people.
- what are your monthly premiums like? hdhps typically have lower monthly premiums.
- what do they include? HDHPs come with a Health Savings Account (HSA) or Health Reimbursement Agreement (HRA), a tax-free account where you can put money specifically to use for future medical costs. try to have at least as much as your deductible saved in your health savings account.
- what counts as an hdhp? for 2021, the deductible is at least $1,400 for individual plans or $2,800 for family plans.
- low deductible health plans
- what is a low deductible health plan (ldhp)? LDHPS typically have lower deductibles but lower monthly premiums than plans with higher deductibles.
- who is an ldhp best suited for? If you need a significant amount of care or require expensive medical services, it may be worth considering a low-deductible plan because your insurer will start to cover costs at a lower rate than high-deductible plans.
- why do you need to know the deductible rollover date?
- what if you have a family health plan?
- premium copays
- how much health care you expect to receive that year
- Needed Coverage: Ultimately, the health care plan you choose should allow you to get the best care for your needs. Whether you visit the doctor frequently or infrequently, your health history should be a major part of your decision-making process. As you weigh your options, think about what expenses you’d be responsible for with a high, low, or intermediate deductible.
- Budget: Your health insurance not only determines the type of care you’re entitled to, it’s also a significant financial commitment. In addition to deductible costs, consumers are responsible for premiums and other out-of-pocket costs such as prescription drugs. Before selecting a health insurance plan, be sure to consider the full terms of the insurance, as well as any costs you may be responsible for.
essential things to know about your annual deductible
Enrolling in a health care plan can be an overwhelming experience: From unfamiliar terminology to rock-bottom costs, there’s a lot to learn before you can find the best coverage for your needs. Whether you’re planning to enroll soon or just need to clear up a long-standing confusion, here are some of the most important things to know about how deductibles work and what to know about yours.
1. how much is your deductible?
You should know how much your deductible is before you join a plan. If the plan has a low premium, the deductible will most likely be high.
Ideally, you should have the money to pay your deductible on hand, or at least be saving for it. Remember, before your insurance company takes over your medical expenses, you must first pay the deductible that you agreed to.
2. your deductible transfer date
Health insurance deductibles generally roll over each January, but some plans may use a different date; for example, health plans through schools or universities may use the academic year.
This date is important because you may want to schedule your appointments and procedures to take place after you meet your deductible and before the year is out. Or, you may need to budget more money for the first part of the year.
Let’s say you have a $1,000 deductible and you meet it in June. any other services you receive during the rest of the year will only cost you copays or coinsurance. but if you wait until January, you will have to pay $1,000 again. You might consider scheduling larger procedures before January to save some money if you’re not planning other expensive services (again topping $1,000) for next year.
3. what doesn’t count toward your deductible
many health plans waive the deductible for services like preventive care or the emergency room fee if you are admitted to the hospital. check your policy so you know where you get a free pass, and take advantage of it.
4. if you have different deductibles
Some plans have separate deductibles for in-network versus out-of-network care. This could cost you more money unnecessarily if you met a deductible and then see a doctor who counts toward the deductible. other. so, find out the rules and always check to see if providers are in-network before you go (don’t make assumptions—every doctor in the same office may not have the same insurance).
if you have a family policy, check to see if there are separate or combined deductibles for each member who is covered. the rules may vary in this case as well.
5. how often you meet your deductible
If you bought health insurance, chances are you expect it to pay for the health care you use. So if you find that every year you get closer to meeting your deductible but never do, you may be tempted to get a plan with a lower deductible so you end up paying less out of pocket.
However, keep in mind:The premiums for lower deductible plans may be higher than what you’d end up saving.
When evaluating this decision, be sure to consider the full cost spectrum of:
choose the correct deductible amount
Now that you know how deductibles work, you may be wondering how to choose the right deductible for your health care needs and financial situation. In this section, we’ll look at some of the things you might want to consider when evaluating your health insurance options.
Things to consider when evaluating health insurance deductibles:
Note: As you calculate your budget and insurance costs, don’t forget that there are ways to maximize your health care deductions to lessen your financial burden.
tomer shoval is the CEO and co-founder of simplee, a free online personal health care expense management tool. connect with him on twitter, facebook or email.