What is a health insurance deductible?
A plan’s deductible is the amount of money you must pay for your medical care before your health insurance begins to pay.
Here are 6 things you need to know about health insurance deductibles:
1. Unlike other types of insurance (e.g., auto or homeowners insurance) where claims are not covered at all until the policy deductible has been met, most health insurance plans do provide some benefits before the deductible is met.
2. There is a tradeoff between premium and deductible — typically the higher a plan’s deductible, the lower the premium (and vice versa). A plan’s metal level will provide a clue as to the plan’s premium-deductible balance. Bronze plans tend to have lower premiums with higher deductibles. Platinum plans have higher premiums and lower deductibles. Click here to read more about metal levels.
3. All Affordable-Care-Act-compliant health insurance policies cover certain preventive care at 100% when that care is delivered by in-network providers, regardless of whether or not the deductible has been met. Click here to read more about preventive services.
4. The deductible resets each plan year. At the start of each policy year, the amount you have paid toward your deductible resets to $0.
5. Most plans have a separate deductible for in-network vs. out-of-network care. Make sure you understand your policy’s deductibles before you receive medical care. Also, be sure you know which providers are in your plan’s network and which ones are not.
6. The maximum out-of-pocket expense for in-network services for an individual is $6,350 in 2014. For families, the 2014 maximum is $12,700. This is true for all plans, regardless of the deductible. NOTE: gold and platinum plans have a lower out-of-pocket maximum.
Understanding Your Health Insurance
Understanding your health insurance policy can be quite tricky. That’s one reason clients come to Virginia Medical Plans. We can help you choose the right coverage, and understand how to use it once you have it!
Give us a call (1-800-867-0800) or send us an email today – [email protected].