What is a deductible?

Health insurance 101 terms to know

A deductible is a set dollar amount that you must pay toward covered services before your full healthcare benefits begin. When you meet your deductible for the year, your full benefits kick in for covered services, meaning you pay only a portion of your care for the rest of the year - often just copayments and coinsurance. Deductibles reset each plan year, so you will need to reach your deductible each plan year before your full benefits begin.

What happens when I meet my deductible?

For example, if you have a $4,500 deductible, you will need to pay for the first $4,500 of covered services yourself. After you meet your $4,500 deductible, you will split the cost of care with your health plan. Depending on your health plan, you might need to pay coinsurance – a percentage of the total cost of care – or a copayment for covered services, after you meet your deductible.

Some family plans may have two deductibles. You may have an individual deductible for each dependent on your plan, as well as a family deductible that applies to everyone on your plan.

What counts towards my deductible?

Only the costs that you pay out of pocket for covered care or services count towards your deductible. Your monthly premiums do not count towards your deductible. Copays often don’t count towards your deductible, either but you can refer to your plan documents to see the details of your plan.

What is an out-of-pocket maximum?

An out-of-pocket (OOP) maximum is the maximum amount of money that you will pay for covered care or services in a plan year. This amount includes the amount you pay for care through deductibles, copays and coinsurance. This amount is generally higher than your deductible. Once you meet your OOP maximum, your plan will pay the full cost of your care for all covered care and services for the rest of your plan year.

Check your deductible

You can review your deductible and how much progress you’ve made toward it by logging in to your member account at members.bcidaho.com.

Posted: December 15, 2021