The deductible in health insurance

Health Insurance

The deductible is one of the most used concepts in medical insurance. However, it is common for people not to know its meaning.

What is it?

Do I have to pay it every time I attend a consultation?

How do I determine which one is right for me?

Health Insurance Deductible (How Do Deductibles Work?) | Mint

Deductible: concept and characteristics


This responsibility of your Obama care health insurance is nothing more than a sum of money that you must pay when you go to a medical service before your insurance begins to cover the expenses that remain in the balance. For example:

If you have an insurance plan with a $1,500 deductible and 20% coinsurance, and you receive a medical bill of $4,000, you would have to pay the first $1,500, the insurance would cover $3,200, and the remaining $800 coinsurance would be your responsibility as well.

“First you pay and then the insurance covers you”

How does it affect my Annual Premium?
In most cases, the lower your liability, the higher your policy premium will be. In this way, you will have a higher monthly premium , but when facing a medical bill, since you have a low deductible, you reach it faster and the company assumes the rest of the expenses before.

What Is An Insurance Deductible? - Napkin Finance

How does it vary within different health Insurance plan?

There are 4 categories of metals within Obamacare insurance plans: bronze, silver, gold, and platinum . Each of them differs in terms of cost sharing between the insurer and the insured. In general, the higher the category (gold and platinum) you will have lower deductibles but quite high monthly premiums.

If we take into consideration the differences between the bronze and silver plans -which are the most popular plans- we can highlight that:

There are silver plans with intermediate price monthly premiums and moderate or $0 deductibles.
Bronze plans will feature low monthly premiums and high deductibles.
Paying a low premium each month can be attractive, but you must take into account the amount of medical care you may need during the year. By choosing insurance with a low deductible, you prevent high expenses due to unexpected medical incidents.

We recommend that you select a plan that balances the cost of your monthly premium and your deductible, always seeking to make the latter as low as possible.

In which cases is it not necessary to pay the deductible?
There are scenarios in which your Obamacare insurance can fully cover the cost of some preventive health service, even though you have not paid your annual deductible. Examples of this are annual check-ups, preventive imaging studies and some laboratory tests .

Do you start from scratch every year?
Yes. When a new year begins the “clock” starts from zero again. For this reason, we recommend that, if you have already exhausted your annual sum, you take the opportunity to have the exams or procedures you need before the end of your coverage term.

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What deductible is favorable for you?
If you plan to enroll in Obama care health insurance , there are several factors to consider when selecting the plan that best suits your needs. The best option for you will depend on: the frequency with which you need to see a doctor, your income and the monthly budget that you can spend on insurance.

Low deductible plans are best for:
Older than 65 years.
People who suffer from chronic conditions (hypertension, diabetes mellitus, thyroid disorders, autoimmune diseases, etc.)
Women planning to become pregnant.
People with scheduled elective surgeries
High deductible plans may be suitable for:
Young and apparently healthy individuals.
People who rarely go to the doctor or need medication.
Those who can afford the expenses of an unexpected medical situation.
A high deductible may be suitable for young, healthy people who won’t be making much use of health insurance. On the other hand, a person of legal age or someone sick, it is recommended that they have a policy with a zero deductible, or as low as possible.

Some interesting data:
If the medical costs (total amount of the medical bill) do not exceed the deductible, you must assume the total amount and pay it out of pocket.
Some medical plans have this responsibility with different amounts, depending on the assistance you are receiving. For example: the deductible for expenses for medical visits may differ from the deductible for drugs prescribed by a doctor.
Family insurance plans may have a deductible for each member and a separate deductible that applies to the family as a whole.
Generally, what you pay for copayment and coinsurance for a medical service does not add to the total of your annual deductible.
Difference between maximum out-of-pocket expense and deductible
The amount of money you pay before the insurer covers you for a service is the deductible. Instead, the out-of-pocket maximum is the total amount of money you pay for the entire year before the insurer covers 100% of covered expenses. Any money you pay (coinsurance, copays, etc.) adds up to your out-of-pocket maximum
Differences between the deductible in health insurance and auto insurance
There is a fundamental difference between them: in your auto insurance you must always pay it in full and in advance so that the insurer begins to cover the costs. On the other hand, in your health insurance it may be the case that the services are covered before you pay this responsibility in full (as is the case with preventive care).

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