What Is a Deductible?

Your deductible is the amount of money you pay out of your own pocket for covered healthcare services before your insurance company starts paying its share.

A Simple Example

Say your deductible is $1,500. You go to the doctor in January and the bill is $300. You pay $300. You need an MRI in March — bill is $800. You pay $800. Now you've paid $1,100 total this year.

In May, you have a $600 procedure. You pay the remaining $400 to hit your $1,500 deductible — then insurance kicks in and pays the other $200.

After that point, for the rest of the year, your insurance starts sharing the cost with you.

What Counts Toward Your Deductible?

Most medical services count — hospital visits, labs, imaging, surgeries. But here's what often surprises people:

• Preventive care (annual physical, vaccines, screenings) usually does NOT count against your deductible — it's often free.
• Copays (flat fees like $30 to see your doctor) may or may not count, depending on your plan.
• Prescriptions often have a separate deductible, or the same one — check your plan.

Family vs. Individual Deductibles

If you cover your family, you likely have two numbers: an individual deductible (per person) and a family deductible (a combined total). Once anyone hits their individual deductible, insurance starts paying for that person — even if the family deductible isn't met yet.

Deductible Resets Every Year

Your deductible resets on January 1st (or your plan's anniversary date). So if you're close to hitting it in December, that's a great time to schedule any care you've been putting off.

Higher Deductible = Lower Premium

Plans with high deductibles (HDHPs) charge you less per month in premiums. You're essentially betting that you'll stay healthy. If you do — you save money. If you don't — you pay more out of pocket before insurance helps. It's a tradeoff worth understanding.