Will I Have to Pay Any Costs After Reaching My Deductible?
You will still have some costs after you meet your deductible, depending on your plan’s cost-sharing requirements.
Premium Payments
Premium payments are what you pay, usually monthly, to keep your health insurance active. You must pay your premium, whether or not you use any healthcare services. Premium amounts vary, depending on your plan, where you live, whether you use tobacco, and your age. You will continue to pay your premium payments after you meet your plan’s deductible.
Copays
Many health insurance plans have copays. These are fixed payments you make each time you receive a medical service. For example, you might owe a $20 copay every time you have a doctor’s visit or get a prescription filled.
Sometimes, copays go toward your deductible, but most times, they do not. You will usually have to pay a share of your covered expenses until you reach your out-of-pocket maximum. In-network copays usually count toward your out-of-pocket maximum.
Coinsurance
Coinsurance is the percentage of the allowed amount for a covered service that you pay after you reach your deductible. An 80/20 coinsurance split is a common coinsurance. This means the insurance pays 80 percent of the bill, while you pay 20 percent.
Out-of-Pocket Maximum
Your out-of-pocket maximum is the most that you will pay for in-network covered medical expenses in a year. Once you reach this amount, your insurance company will pay 100 percent of your costs for the rest of the year, with the exception of your premium. Premiums do not count toward your out-of-pocket maximum.
Your deductible counts toward your out-of-pocket maximum, so when you pay your deductible, you are closer to reaching your max.
Here’s an example of how your deductible, coinsurance, and out-of-pocket maximum work.
- Let’s say your health insurance plan has a $1,000 deductible, a 20 percent coinsurance and a $4,000 out-of-pocket maximum. You have surgery, and the bill is $10,000. You will pay the first $1,000 to reach your deductible. Then, you will split the remaining $9,000, with your insurance company paying $7,200 and you paying $1,800. You have now paid a total of $2,800 toward your out-of-pocket maximum. Once you pay another $1,200 toward other covered expenses during the year, your insurance company will pay 100 percent of any other covered expenses.
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