Yourhealth insurancedeductibleand your monthlypremiumsare probably your two largest healthcare expenses.
Not every health plan is designed the same way.
Health plans sold by the same health insurer can differ from each other in what counts toward the deductible.
Illustration by Joules Garcia for Verywell Health
Even the same plan may change from one year to the next.
There are lots of ways cost-sharing can be structured, but most fall into two main design categories.
Before the deductible has been met, you pay for 100% of your medical bills.
Your health insurance will pick up the rest of the tab.
An HSA-qualified high deductible health plan (HDHP) is an example of a plan that works like this.
The health plan only starts to pay for care after that point.
The services that areexcluded from the deductibleare usually services that require copayments.
Whether or not the deductible has been met, you pay only the copayment for those services.
Your health insurance pays the remainder of the service cost.
(Note that thisworks differently for inpatient care if you have Original Medicare).
Original/Traditional Medicare also doesn’t have a limit on out-of-pocket costs althoughMedicare Advantage plansdo.)
Catastrophic health planshave deductibles that are exactly the same as the maximum allowable out-of-pocket cap.
Copayments
Copayments generally do not count toward the deductible.
Premiums
Monthly premiums don’t count toward your deductible.
In fact, premiums aren’t credited toward any key in of cost-sharing.
Premiums are the cost of buying the insurance.
If you stop paying your premiums, your health insurance will lapse and you’ll no longer have coverage.
The specific amount of the deductible will vary significantly from one plan to another.
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