Deductible

What is a Deductible?

A deductible is a set amount you pay for medical services before your plan begins to pay.

A Deductible Example

Example: $750 service, with a $300 deductible and 20% coinsurance

Your deductible responsibility: $300

Your coinsurance responsibility: $90 ($750 - 300 = $450. $450 x 20% = $90)

Your total responsibility on this service: $390

Understanding Deductibles

Deductibles are a way for the insurance company and the patient to share costs. By putting the burden of the deductible on the patient first, patients are sometimes deterred from receiving all of the care that they would like because of the financial burden.

Common Deductible Amounts

Deductible amounts vary by plan type and plan enrollees.

Individual vs Family Deductible: Individual plans (for one enrollee) tend to be lower than family deductibles (for multiple enrollees)
High Deductibles: High deductible health plans almost always have higher deductibles than standard, PPO health plans. A High Deductible Health Plan (HDHP) is a type of health insurance plan that is designed to give the consumer lower fixed monthly premiums in exchange for being responsible for higher out-of-pocket costs if you do engage in healthcare services.
For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.) Source
In-Network vs Out-of-Network Deductibles: In-network deductibles tend to be lower than out-of-network deductibles.

Does everything apply to the deductible?

Depending on your plan, different services may or may not apply to your deductible. On High Deductible Health Plans, typically all services apply to the deductible. On a standard PPO or HMO plan, most office visits are subject to a copay, while major services such as hospital stays may be subject to the deductible. To determine what applies to your deductible, read your open enrollment summary or contact your insurance company at the number listed on the back of your insurance card.

How do I know how much my deductible is?

Some insurance cards list the deductible amount on the front of the card to make it easy for the patient and the provider to pay or collect money up front. If your card does not have the deductible listed, you can look at your plan benefit documents or call the phone number on the back of your insurance card.