Most health insurance plans include a deductible, which is an amount you must pay out-of-pocket for your healthcare before your insurance company begins to kick in for covered healthcare services. In general, you will have to pay the full cost for covered services until you’ve reached your annual deductible, at which point the insurance company will begin to pay its portion of your medical costs. Deductibles can work differently depending on your health insurance plan.
Generally, all payments you make for covered healthcare services will count toward your annual deductible, unless the payment is considered a copay. Copays are a fixed amount you pay to see your doctor or a specialist. Specialist, urgent care facility and emergency room copays are generally higher than that of your primary care physician. No matter how many copays you make they generally don’t count toward your deductible and you continue to pay them even after your deductible has been met.
Other plans require that your doctor visits be subject to your deductible and coinsurance. If so, then your deductible is the dollar amount you pay for doctor’s visits as well as other healthcare services before your insurance plan begins to pay. For instance, if your deductible is $500, then your plan will not pay anything until you have spent the full $500 on qualified medical expenses.
When your visit to the doctor is subject to coinsurance, your share of the cost is calculated as a percentage of the total charge for the service. You pay any remaining deductible plus the coinsurance payment percentage. For example, let’s say your coinsurance is 20 percent, meaning you’re responsible for paying 20 percent of any doctor’s bill. If your doctor’s bill is $100 and you’ve already met your deductible, then you will pay $20 and your insurance company will pick up the remaining $80. Once your out-of-pocket maximum has been met the plan pays 100 percent for covered in-network services.