What happens once I meet my deductible?

2 min. readlast update: 08.06.2023

Once you meet your deductible in a health insurance plan, the way your insurance coverage works may change. Here's what typically happens after you meet your deductible:

  1. Cost-Sharing Shifts:

After meeting your deductible, the cost-sharing arrangement with your insurance company shifts. Prior to reaching your deductible, you're responsible for paying the full cost of medical services (except for preventive care, which is often covered at no cost). After meeting the deductible, your insurance company starts sharing the costs of covered services with you.

  1. Coinsurance or Copayments:

Once you've met your deductible, you may start paying coinsurance or copayments for medical services instead of covering the full cost. Coinsurance is a percentage of the cost of a service that you pay, while a copayment is a fixed amount you pay for each service. Your insurance plan will specify the coinsurance or copayment amounts for different services.

  1. Out-of-Pocket Maximum:

Your health insurance plan has an out-of-pocket maximum, which is the maximum amount you have to pay for covered medical services in a given year. This includes deductibles, coinsurance, and copayments. Once you reach the out-of-pocket maximum, your insurance company will cover 100% of the cost of covered services for the rest of the plan year.

  1. Covered Services:

It's important to note that only covered services count toward meeting your deductible and out-of-pocket maximum. Services that are not covered by your insurance plan will not contribute to these amounts.

  1. Plan Specifics:

Remember that the details of how your insurance coverage works after meeting the deductible can vary based on your specific health insurance plan. Some plans might have different deductibles for different services (e.g., a separate deductible for prescription drugs). It's essential to review your plan's documents or contact your insurance provider to understand the specifics of your coverage.

  1. Plan Year Reset:

The deductible and out-of-pocket maximum usually reset at the beginning of the plan year, which is typically January 1st. This means that any amounts you've paid toward your deductible and out-of-pocket maximum in the previous year will start over at zero.

In summary, meeting your deductible marks a transition in your health insurance coverage. Your insurance company will begin sharing the costs of covered services through coinsurance or copayments, and you'll have a cap on your out-of-pocket expenses for the plan year. Always refer to your insurance plan documents or contact your insurance provider for accurate and up-to-date information about your coverage.

Was this article helpful?