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Health insurance deductible

The deductible on your health insurance policy is the amount that you must pay before your insurance starts paying. Deductible amounts vary greatly and the depend on many different factors. It is important to understand your deductible before you sign up for your insurance program.

What affects my health insurance deductible?

1. Premiums Vs. Deductibles

The number one factor influencing the cost of your deductible is your premium, the amount that you pay monthly to keep your insurance. If your insurance plan has higher premiums, you will generally pay a lower deductible.

When deciding which plan is better for you, consider your health and how often you use healthcare services. If you are in generally good health and you use few healthcare services, a higher deductible plan with lower premiums may be ideal. If you have a chronic condition, an unhealed injury, children on your family plan, you frequently suffer sports injuries, or your job is physically demanding, a higher premium, lower deductible plan might be best.

2. Time of the Year

Deductibles are calculated annually, which means you have to pay it again each year. If you know you require medical visits, therapy, tests or other planned healthcare appointments, try to schedule them early in the year, so you can fill your out-of-pocket deductible sooner and pay less for subsequent healthcare needs. Once you’ve filled your out-of-pocket deductible, your insurance will pay for your services at the rate stated in the policy for the rest of the year, so it’s best to fit in all the care you need early on.

3. Copays and Deductibles

While a deductible is a cost that must be fulfilled yearly by the insurance recipient before the insurance company pays their part, a copay is a set amount that must be paid by the recipient for most healthcare services, such as doctor’s visits, emergency room visits, or therapy. A copay usually does not go toward the deductible. However, if your plan designates copays as a part of total deductible costs, your deductible will be met much faster and you will ultimately pay less.

4. Employer Plan

Employers providing health insurance plans must pay at least half of their employees’ premiums, and employers with 50 or more employees must provide insurance. Given the relationship between premiums and deductibles (see above), many employers choose a higher deductible plan with lower premiums in order to shoulder less of the costs. The plan that your employer chooses will change your deductible.

5. Health Savings Account

A health savings account (HSA) is an account set aside for health insurance deductibles, used only for certain high-deductible policies. Money put into this account is not subject to income tax, so it makes sense in many cases to use this. Withdrawing these funds for uses other than medical expenses makes them subject to tax and penalties, so it behooves the account holder to dedicate the funds to medical expenses. If you have an HSA, your entire deductible may be covered by the money you (or your employer) have already put away.

6. Single vs Family Plan

If you are the only person on your health insurance plan, you only have one deductible. However, if your spouse and children are also on your plan, there are separate deductibles for each person and a total family deductible. This means an individual family member can fulfill their own deductible and the insurance company will pay their share of subsequent expenses for that person (but not others in the family). Alternatively, the deductible for the family can be met through cumulative expenses from all family members, and subsequent expenses incurred by any family member will be paid by the insurance company.

7. Your Spouse’s Plan

Many individuals and families receive insurance through their employers. If you and your spouse both have access to family health insurance plans and one works significantly better for you, you can both opt into that plan, and waive the other. This way, you can choose the plan with the deductible, copay and premium structure you prefer. Keep in mind that some employer plans penalize spouses that waive their own employer plans.

Don’t forgo the treatment that you need because you aren’t sure about your insurance. Your health insurance is there to cover you when you’re sick or injured.  If you don’t understand something in your policy, call the number provided by your insurance company. If you’re not sure if a treatment is covered in your plan, your healthcare provider can also help.

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