Your deductible is the amount you pay toward covered healthcare services before your insurance starts to cover costs for those services.
Once you meet your deductible for the year, your health insurance provider will start to cover costs for the services included in your plan, as long as you use in-network providers.
For example, if your deductible is $4,000, you will have to pay $4,000 total for covered services before your insurance starts making payments.
However, your insurance company will usually not cover all of your costs after you meet your deductible. In most cases, you will still have to pay copayments and coinsurance.
Which costs count toward my deductible?
Specifics can vary from plan to plan, so it’s important to check your insurance plan documents to know exactly which costs count toward your deductible.
In most cases, though, any bills you pay for covered healthcare services count toward your deductible.
For example, if you get an $800 bill for a service that’s covered under your insurance plan, then the money you pay for that bill will count toward your deductible.
However, there are also several kinds of payments that do not count toward your deductible. Read on to find out about these important exceptions.
Which costs don’t count toward my deductible?
There are three major kinds of costs that don’t count toward your deductible: copayments, premium payments, and payments for any service that is not covered by your insurance plan.
Copayments are payments you make toward routine covered services at the time you get the service.
- For example, you might pay a $35 copayment every time you see your primary care doctor.
- Copayments usually do not count toward your deductible, but they do count toward your out-of-pocket maximum.
Your premium is the amount you pay regularly for your insurance plan.
- If you have insurance through your job, then your premium is probably deducted from your paycheck.
- Your premium payments do not count toward your deductible or your out-of-pocket maximum.
- Essentially, your premium is the amount you pay for purchasing the health insurance plan, so you have to keep paying it regardless of other costs.
The other major kind of healthcare cost that doesn’t count toward your deductible is payment for services not covered by your plan.
- For example, if your plan does not cover acupuncture services and you pay for acupuncture sessions out of pocket, the cost of those sessions does not count toward your deductible.
- Depending on your plan, payments to out-of-network providers (even for services covered under your plan) may not count toward your deductible either.
- These costs generally do not count toward your out-of-pocket maximum.
How does coinsurance relate to my deductible?
Coinsurance is a percentage of the cost for covered services that you pay after your deductible has been met.
For example, if you’ve already paid your full deductible for the year, then you might pay 15% of the cost for a covered service while your insurance company pays the remaining 85%.
Coinsurance does not count toward your deductible because, in most cases, you don’t pay it until after the deductible has been met.
However, coinsurance usually does count toward your out-of-pocket maximum.
How do I know what my deductible is?
Deductibles can vary widely, depending on your insurance company and the specifics of your insurance plan.
Here are three ways to find out what your deductible is:
- Check your plan documents: Your paper or digital copy of your plan documents should clearly specify what your deductible is.
- Use your online portal: Most insurance companies have an online portal where you can access your plan details and find out what your deductible is.
- Contact customer service: If you can’t find your deductible or are unclear on the details of your specific plan, you can always contact your insurance company directly. Their customer service phone number is likely available on their website, and it’s usually printed on the back of your insurance card as well.