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What goes towards my health insurance deductible?

The Affordable Care Act’s Tax penalty for citizens that do not obtain health insurance has inspired quite a few people to shop for health insurance for possibly the first time in their lives. The new shoppers tend to have a lot of questions and one of the more popular ones is “what goes towards my deductible?“. This makes sense as the deductible is one of the prominent features of a health plan. It is also one of the largest factors in determining the premium.

Many people think that their health insurance deductible will work like their car insurance deductible but this is generally incorrect. Your car insurance deductible is “per occurrence”. So for example; if you have a $500 deductible on your auto insurance policy and you get into an accident today you will be responsible for the first $500 of repair costs. If you get in another accident tomorrow you will again be responsible for the first $500 of the costs. Where as under most health insurance policies all incidents during a given period, usually called the contract or calendar year, accumulate towards the deductible.Once it is met you will not pay anymore deductible charges for the rest of that contract or calendar year.

But wait we still didn’t answer the original question as to what goes towards the deductible. It is actually easier to explain what does not go towards your deductible. On most plans the only services that do not go towards your deductible are:

  • doctor visits
  • prescription drugs
  • Emergency Room Trips
  • Urgent Care Center Services

These services are typically covered by fixed fees called co-pays . So nearly all other services including; inpatient hospital services, outpatient hospital services, lab work, diagnostic testing,, surgery, durable medical equipment, diabetic supplies and much more go towards your deductible.

Recently there has been a trend where select health insurance companies have began covering diagnostic tests and lab work with a small fixed co-pay as opposed to subjecting these services to the deductible. This is a big deal! traditionally many policyholders spend a lot of their deductible dollars on things like Cat Scans, MRIs, blood work and X-rays. If your health insurance carrier limits your out of pocket to a reasonable co-pay for these types of services you could potentially save a good deal of money.

Now you can see why the deductible is one of the major cost drivers of your health insurance plan. So if you are shopping for health insurance coverage you will now have a little more knowledge on your side so you can make the right selection.

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