How Do I Meet My Health Insurance Deductible?

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   Marlin McKelvy

   President, Consumer Directed Benefit Solutions, Memphis, Tennessee

   Your health insurance deductible is the amount that the covered individual must pay out of their own pocket before the health insurance plan begins paying for covered health care expenses.  Deductibles can vary from one insurance policy to another.  As an example, let's say you have a health insurance policy with a $2000 deductible followed by 100% co-insurance coverage after that amount.  You are then hospitalized for heart surgery under this policy and the total bill is $50,000.  You would be 100% financially responsible for the first $2000 of that bill (your deductible) and the health insurance carrier would pay the remaining $48,000.  You have "met" your deductible by incurring expenses in excess of your plan's deductible.  As many healthcare providers and hospitals will tell you, there is a difference in someone "meeting" their deductible and actually paying their deductible expenses.  So, in our example, as long as the policy holder keeps paying their health insurance premiums their health insurance will remain in effect even if the policy holder pays none or only a portion of their $2000 deductible amount.  This is why a growing number of consumers are receiving demands for upfront payment of their deductible and co-insurance cost sharing amounts from some healthcare providers before they will provide services.  I just had a friend ask me about this very situation for one of her coworkers who had recently learned she was pregnant and who was told by their OB/GYN that they wanted payment for the person's $1500 deductible and their 30% co-insurance cost sharing for the OB/GYN to provide their services to that person.

   Answered on April 20, 2014

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