Deductible
The amount you pay out of pocket each year before your insurance starts paying. Resets every plan year.
A deductible is the dollar amount you must pay for covered health services in a given plan year before your insurance begins paying. Plans differ widely — a high-deductible health plan (HDHP) might have a $7,500 single-person deductible while a 'platinum' ACA plan might have $0. Some services (preventive care under ACA §2713) are covered with no deductible at all. Family deductibles are usually 2× the individual deductible. The deductible is one piece of cost-sharing; the others are coinsurance, copays, and the out-of-pocket maximum.
Frequently asked questions
What is deductible?
A deductible is the dollar amount you must pay for covered health services in a given plan year before your insurance begins paying. Plans differ widely — a high-deductible health plan (HDHP) might have a $7,500 single-person deductible while a 'platinum' ACA plan might have $0. Some services (preventive care under ACA §2713) are covered with no deductible at all. Family deductibles are usually 2× the individual deductible. The deductible is one piece of cost-sharing; the others are coinsurance, copays, and the out-of-pocket maximum.
Related terms
- CoinsuranceYour percentage share of a healthcare service cost after you've met your deductible — usually 10-30%
- CopayA fixed dollar amount you pay for a specific healthcare service (e.g., $30 for an office visit).
- Out-of-pocket maximum (OOP max)The most you'll pay out of pocket in a plan year before the insurer covers 100% of covered services.
- Preventive servicesHealthcare services required by ACA §2713 to be covered at $0 cost-sharing on in-network — including
Sources
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