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How Deductibles Work

The deductible is what you pay out of your own pocket before your insurance begins to pay a share of your costs.

For example, let’s say you break your wrist. If you have a deductible, you pay the full “negotiated” costs of all in-network services until you reach the deductible. The “negotiated” costs are the payments providers (doctors, hospitals, labs, etc.) have agreed to accept for a particular service from the insurance carrier.

It Depends on Your Medical Coverage Level

Bronze, Silver, and Gold have a traditional deductible. Once a covered family member meets the individual deductible, your insurance will begin paying benefits for that family member.

Charges for all other covered family members will continue to count toward the family deductible. Once the family deductible is met, your insurance will pay benefits for all covered family members.

Under the Bronze option, prescription drug expenses apply toward the annual deductible.

The annual deductible doesn’t include amounts taken out of your paycheck for health coverage.

The Platinum coverage level does not have an in-network deductible. Keep in mind that as a trade-off for no deductible, the Platinum coverage level is usually the most expensive coverage level per paycheck.

Do You Use Out-of-Network Providers?

Out-of-network charges will not count toward your in-network deductible or out-of-pocket maximum. The same goes for in-network charges—they will not count toward your out-of-network deductible or out-of-pocket maximum.

And some insurance carriers in CA, CO, DC, GA, MD, OR, VA, and WA do not cover out-of-network benefits at all.

Make It Yours To Go