![]() ![]() A deductible is a fixed amount a patient must pay during a given time period (usually the plan year) before their health insurance benefits begin to cover the costs. A copay is a fixed amount paid by a patient for receiving a particular health care service, with the remaining balance covered by the person's insurance company. It’s one way to minimize routine health care costs while still maintaining coverage for worst-case scenarios.ĭeductible vs Copay: what’s the difference?Ĭopays and deductibles are both features of health insurance plans and dictate how much the insured pays for health services, though amounts and frequencies vary. Some people choose to combine an HDHP with a health savings account (HSA), the latter of which lets you pay for qualifying medical expenses with contributed funds that are not subject to federal income tax. On the other hand, you also typically pay for all health care costs out of pocket until the deductible is met, which can still amount to several thousands of dollars. If you have a medical emergency resulting in tens of thousands of dollars in medical expenses, you can get coverage for any covered health services that go over the deductible. Also known as “catastrophic health plans”, these are meant to protect people if the worst happens. These plans can be appealing for those who want to minimize monthly premium costs or who don’t anticipate having many health care needs throughout the year. describes such plans as having an individual deductible of at least $1,350 or a family deductible of at least $2,700. These plans usually offer the lowest monthly premiums. $2,500 X 30% = $750 (you pay)$2,500 X 70% = $1,750 (insurance pays) High-deductible plansĪ high-deductible health plan (HDHP) is exactly as it sounds: a plan that has a high deductible. If the total cost for treating your leg was $2,500, you’d only be responsible for $750: You took an awesome trip to the Sundance Film Festival and decided to take a day for skiing, but the slopes were brutal and you broke your leg. Coinsurance is usually defined as a percentage of costs that you are responsible for, which usually breaks down as follows:Īs an example, let’s say you have a silver plan that has a $2,000 deductible, and you have met the deductible. Typically, after a deductible is met, you share the cost of healthcare services with the insurance company. a family of four may have a family deductible of $2,000 that breaks down to an individual deductible of $500 per member). Family deductibles may be one lump sum that applies to the entire family or each family member covered under the plan may have an individual deductible that goes toward the family deductible (i.e. This varies by coverage type, so be sure to check your certificate of coverage.ĭeductibles can also be broken down by individual or family. Many preventive services and, in some cases, primary care, are offered at no cost to the policyholder. Not every health service is related to your deductible, either. car insurance) in that the latter is usually applied per each claim, whereas health insurance deductibles cover the entire year. Health insurance deductibles are different than other insurance deductibles (e.g. The lower the deductible on your health plan, the higher the monthly premium usually is. An important thing to note is that deductibles and monthly premiums tend to be inversely related. The quickest definition for a deductible is that it lets you know what you're paying out of pocket before your insurance kicks in to cover services. ![]()
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