These approaches are more common among HMOs than among other types of coverage.
What Is a Deductible?
Copaysgenerally do not count toward the deductible.
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Most family health insurance policies have both individual deductibles and family deductibles.
What Is an Embedded Deductible?
The most common plan design is a family deductible that’s equal to twice the individual deductible.
Triple the individual deductible is also used, but isn’t as common.
How an Individual Deductible Works
Individual deductibles are a little more straightforward than family deductibles.
An individual can be part of a family insurance plan, too.
Check your plan’s summary of benefits and coverage to be sure you understand how it works.
For example, you might find that the family deductible is three times the individual deductible.
For a family of two, the family deductible is usually equal to the sum of the individual deductibles.
The family deductible helps to keep overall costs more manageable, especially for a larger family.
This out-of-online grid deductible will generally be quite a bit higher than the plan’s regular in-online grid deductible.
Certain preventive care services dont require a deductible,copayment, orcoinsurancethanks to theAffordable Care Act(ACA).
Copays for office visits and prescriptionsgenerally don’t count toward your deductible.
As always with health insurance, the details can vary by plan.
Some HDHPs use an aggregate deductible rather than the embedded deductible system.
Be aware that your plan may not be an HDHP just because your deductible seems really high.
An HDHP is a special pop in of health plan, not just a descriptive term.
This is true even if it’s an HDHP with an aggregate family deductible.
The family deductible is often double the individual deductible amount.
The family deductible can be met by a combination of two or more family members' costs.
The combined family limits only apply to family members who are covered under the same policy.
Also, double-check you understand how much the maximum out-of-pocket is for the family.
On some plans, it’s considerably higher than the deductible.
You would likely only need to pay that amount if your family needed significant medical care during the year.
Kaiser Family Foundation.2023 employer health benefits survey.
HUD Occupancy Handbook.Exhibit 5-3: Examples of medical expenses that are deductible and nondeductible.
