How a health insurance deductible works
The amount you pay for covered care in a plan year before the plan starts paying its share. Some services are covered before you reach it.
What the deductible actually covers
A deductible is the amount of covered medical cost you pay yourself before the plan begins paying its share. If your deductible is $3,000, you pay the first $3,000 of covered services at the plan's negotiated rate, then coinsurance starts.
The negotiated rate matters. An in-network provider bills the plan's contracted price, which is often far below the list price, and only that contracted amount is applied to your deductible.
What you get before you reach it
Every Marketplace plan covers preventive services at no cost to you, whether or not the deductible is met.
- Annual wellness visit and routine screenings
- Immunizations recommended for your age group
- Contraception and pregnancy screenings
- Copay-based visits and generic drugs, on plans that list a copay instead of coinsurance
Trading deductible against premium
A lower deductible is bought with a higher monthly premium. Bronze plans carry the highest deductibles and the lowest premiums. Gold plans invert that.
If you take a maintenance drug or expect a procedure this year, run the total: twelve monthly premiums plus the deductible you expect to spend. A plan that costs $60 more each month but $2,500 less in deductible is the cheaper plan for anyone who will use it.
Cost sharing reductions change the math
If your household income is between 100 and 250 percent of the federal poverty level, silver plans carry a built-in cost sharing reduction that lowers the deductible and the out-of-pocket maximum without raising the premium. This only applies to silver. It is the reason a silver plan often beats a bronze plan at those incomes.
Common questions
- Does my premium count toward my deductible?
- No. Premiums are the cost of holding the policy and never apply to the deductible.
- Do family members share one deductible?
- Most family plans have both an individual deductible and a family deductible. Each person's spending counts toward their own and toward the family total.
- What happens if I switch plans mid year?
- The new plan starts a fresh deductible. Spending on the old plan does not carry over, so mid year switches are worth checking against what you have already paid.