Your deductible is the amount you pay out-of-pocket before your insurance starts covering costs. It's one of the most important - and most confusing - parts of any health plan.
How Deductibles Work
If your plan has a $3,000 deductible, you pay the first $3,000 of covered medical expenses yourself. After that, your plan starts paying its share (usually 70 to 90%, depending on the metal level).
What Counts Toward Your Deductible
- Doctor visits (if not covered by a copay before the deductible)
- Lab work and imaging
- Hospital stays
- Prescription drugs (depending on the plan)
- Emergency room visits
What Typically Doesn't Count
- Monthly premiums
- Out-of-network costs (on some plans)
- Services not covered by the plan
Preventive Care: The Exception
Under the ACA, preventive care (annual checkups, vaccinations, cancer screenings) is covered at 100% - even before you meet your deductible. This is true for all marketplace plans.
Deductible vs. Out-of-Pocket Maximum
Your deductible is what you pay before insurance kicks in. Your out-of-pocket maximum is the most you'll pay in a year - after reaching it, insurance covers 100%. These are different numbers, and both matter.