Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada
A health insurance deductible is the amount you must pay before your benefits "kick in" and begin paying (for most services - some benefits, such as preventive care, provide coverage immediately). The deductible amount varies by plan.
For example, under the new Affordable Care Act, a catastrophic plan may feature a $6,350 deductible, a bronze plan may feature a $5,000 deductible, a silver plan may feature a $3,000 deductible, a gold plan may feature a $2,000 deductible, and a platinum plan may feature a $0 deductible. These figures are not the same for all plans on each metal level.
The higher the deductible, the lower your monthly premium and vice versa.
I hope the information is helpful - please feel free to contact me for help and if you have any other questions. Thanks very much.
Insurance Concierge, M&G Insurance, Lake Oswego Oregon
Another way to understand deductible is this...
When a bill comes in for major services you will have to pay the amount of your deductible first. After that, most times, you will have to pay a co-insurance amount. Most co-insurances are 80/20, 70/30 or 50/50. That means you pay the next 80% of each bill up to the Max Out of Pocket for all in network charges. The insurance company would pick up the 20% that you didn't pay. After the Max Out of Pocket was paid you would owe 0% (as long as you used doctors and hospitals whom are in network) and the insurance company would pay 100% until Dec 31st when you would have to start all over meeting your deductible again and Max OOP.
Example: Your deductible is 2,500 an your Max Out of Pocket is 7,150 (most that can be charged for 2017).
You pay the first 2,500 of a 15,000 claim and that leaves 12,500. Then you pay 20% (or 30% or 50% depending on the plan you choose) which is an additional 2,500. The insurance company pays the other 80%. That means for this claim of 15,000 your total is the deductible of 2,500 and the 20% coinsurance above of 2,500 for a total of 5,000. You would NOT have met your Max Out of pocket for the year (7,150) so the next bill that comes in you would continue to pay 20% of until you reached a total paid of 7,150 (INCLUDING the 2,500 deductible). Keep in mind that co-pays do not go towards the deductible in most cases and neither do prescriptions; however they do go towards the Max Out of Pocket for the year.
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For example, under the new Affordable Care Act, a catastrophic plan may feature a $6,350 deductible, a bronze plan may feature a $5,000 deductible, a silver plan may feature a $3,000 deductible, a gold plan may feature a $2,000 deductible, and a platinum plan may feature a $0 deductible. These figures are not the same for all plans on each metal level.
The higher the deductible, the lower your monthly premium and vice versa.
I hope the information is helpful - please feel free to contact me for help and if you have any other questions. Thanks very much.
When a bill comes in for major services you will have to pay the amount of your deductible first. After that, most times, you will have to pay a co-insurance amount. Most co-insurances are 80/20, 70/30 or 50/50. That means you pay the next 80% of each bill up to the Max Out of Pocket for all in network charges. The insurance company would pick up the 20% that you didn't pay. After the Max Out of Pocket was paid you would owe 0% (as long as you used doctors and hospitals whom are in network) and the insurance company would pay 100% until Dec 31st when you would have to start all over meeting your deductible again and Max OOP.
Example: Your deductible is 2,500 an your Max Out of Pocket is 7,150 (most that can be charged for 2017).
You pay the first 2,500 of a 15,000 claim and that leaves 12,500. Then you pay 20% (or 30% or 50% depending on the plan you choose) which is an additional 2,500. The insurance company pays the other 80%. That means for this claim of 15,000 your total is the deductible of 2,500 and the 20% coinsurance above of 2,500 for a total of 5,000. You would NOT have met your Max Out of pocket for the year (7,150) so the next bill that comes in you would continue to pay 20% of until you reached a total paid of 7,150 (INCLUDING the 2,500 deductible). Keep in mind that co-pays do not go towards the deductible in most cases and neither do prescriptions; however they do go towards the Max Out of Pocket for the year.