What Is a Health Insurance Deductible?

Your deductible plays a big role in determining your premium and your overall health care costs.

Written by Kat Tretina / March 23, 2022

Quick Bites

  • A deductible is how much you pay for health care services before your insurance kicks in to cover at least a portion of the costs.
  • Many people don’t understand how deductibles work, which may lead them to choose the wrong health plan.
  • The amount of your deductible can affect your premiums and out-of-pocket costs.
  • The average deductible for a single person in an employer health plan is $1,669.

You’re starting a new job, and it includes health benefits. Yay! But as you review your options, you start to panic. There are all sorts of terms that you don’t understand: Health insurance deductibles. Copays. Coinsurance. Formularies. The same thing can happen at open enrollment every fall when you get to pick a new health insurance plan.

If you’re confused by all the terminology, you’re not alone. In a survey from the National Association of Insurance Commissioners, 32% of respondents said they didn’t know how much their deductibles were, and 25% weren’t aware of their copayment amounts.[1]

But it’s not as complicated as it sounds. By understanding how health insurance deductibles work and why they are important, you can make a more informed decision when you’re choosing a health plan.

Inside this article

  1. Health insurance deductibles
  2. Copays and coinsurance
  3. Deductibles and premiums
  4. Choosing higher deductibles

What is a health insurance deductible?

A health insurance deductible is how much you have to pay out-of-pocket each year before your health insurance plan starts to pick up a share of the costs. (A deductible typically doesn’t apply to certain preventive services, which are free without any patient cost-sharing.)[2]

If your health insurance deductible is $2,000, for example, you’ll need to foot the bill for all the health care services covered by your plan (except eligible preventive services) until you reach that threshold. Once you hit your deductible, your health insurer will start covering a portion of your medical costs, or all of it.

The average deductible for a single person in an employer health plan is $1,669.[3]

Your deductible is a key factor in determining your overall health care costs, according to John Millen, a health insurance expert with Affordable Health Insurance. “If the employer offers more than one plan, it’s common to see different levels of deductibles being offered,” he says.

How does a deductible differ from a copayment and coinsurance?

In addition to a deductible, you will have copayments or coinsurance (or both) with any health insurance policy. Here’s what they are:

Copayments

Copayments (or copays) are a fixed dollar amount that you pay for a covered medical service, such as a doctor’s visit.

Coinsurance

Coinsurance is the percentage of the cost of covered medical services that you're responsible for paying. You also pay coinsurance after you've met your deductible.[4]

Let’s say you have a health plan with a $2,000 deductible and 20% coinsurance. Your doctor charges $100 for an office visit. Since you haven’t yet met your deductible, you’ll have to pay the entire $100 bill. However, after you hit your deductible, your health insurance will cover a portion of the costs. In this case, you’ll pay 20% of the $100 visit, or $20.

How do health insurance deductibles affect premiums?

In general, the higher your health insurance deductible is, the lower your monthly premiums will be. This is because you’re shouldering more of the initial cost of care yourself. Conversely, if you choose a health plan with a low deductible, your monthly premiums will be higher because the health insurance company is covering costs sooner.

High-deductible health plans (HDHPs), which have even higher deductibles than traditional plans do—for 2022, the IRS defines HDHPs as any plan with a deductible of at least $1,400 for an individual and $2,800 for a family—are popular with consumers who want to keep their monthly premiums low. Plus, with an HDHP you can fund a health savings account (HSA) that lets you pay for eligible out-of-pocket health care expenses with pre-tax dollars.

Tip: With an HDHP in 2022, your total out-of-pocket expenses, including your deductible, copayments and coinsurance, cannot exceed $7,050 for an individual and $14,100 for a family. Once you reach that threshold, your insurer covers the remainder.[5]

If you’re considering an HDHP, be sure to factor in your expected medical costs for the year. You’ll need to pay all your expenses until you reach your deductible, which can strain your budget if you face unexpected health costs.

“If someone doesn’t have adequate savings, an HDHP can be troublesome,” Millen says. “If you can’t afford to pay $2,000 or $3,000 upfront for medical expenses, then a lower deductible will be a better fit for you.”

Keep in mind that health insurance deductibles are just one thing to consider when choosing a health plan. Other important factors include:

  • Your premium payments

  • The type of coverage you need

  • Your coinsurance amounts

  • Whether your preferred doctors and hospitals are in-network

When does a higher deductible make sense?

Before you opt for a plan with a high deductible in the hopes of saving money, look at your previous year’s spending and how much care you expect to need in the upcoming year. Consider how often you tend to go to the doctor, fill prescriptions or receive any kind of medical treatment.

If you seldom see a doctor and don’t take prescription medications on a daily basis, a higher deductible can make sense. You’ll have coverage in case of a medical emergency or serious injury, but your monthly premiums will be relatively low.

If, however, you have a chronic health condition, expect to make multiple doctor visits over the year or take prescriptions on a regular basis, you will likely pay more out-of-pocket with a higher deductible plan than if you had opted for a plan with a higher monthly premium and a lower deductible. Higher premiums will be offset by lower overall costs.

Article Sources
  1. “Nearly Half of Consumers Don’t Understand How Their Health Insurance Would Pay for Coronavirus Testing and Treatment, According to A New NAIC Survey,” National Association of Insurance Commissioners, https://content.naic.org/article/news_release_nearly_half_consumers_dont_understand_how_their_health_insurance_would_pay_coronavirus_testing_and.htm.
  2. “Glossary: Deductible,” Healthcare.gov, https://www.healthcare.gov/glossary/deductible.
  3. “2021 Employer Health Benefits Survey,” Kaiser Family Foundation, https://www.kff.org/report-section/ehbs-2021-summary-of-findings.
  4. “How to Pick a Health Insurance Plan,” Healthcare.gov, https://www.healthcare.gov/choose-a-plan/your-total-costs.
  5. “What Is a High-Deductible Health Plan?” Healthcare.gov, https://www.healthcare.gov/glossary/high-deductible-health-plan.

About the Author

Kat Tretina

Kat Tretina

Kat is dedicated to teaching people how to pay down debt, boost their incomes and reduce financial stress. Her work has been published by Reader's Digest, The Huffington Post, Forbes Advisor and more.

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