The deductible is what you pay out of your own pocket before your insurance begins to pay a share of your costs.
For example, let’s say you break your wrist. If you have a deductible, you pay the full “negotiated” costs of all in-network services until you reach the deductible. The “negotiated” costs are the payments providers (doctors, hospitals, labs, etc.) have agreed to accept for a particular service from the insurance carrier. Insurance carrier member sites and apps have resources that can help you look up the cost of care.
It Depends on Your Medical Coverage Level
Bronze Plus has a traditional deductible. Once a covered family member meets the individual deductible, your insurance will begin paying benefits for only that family member.
Charges for all other covered family members will continue to count toward the family deductible. Once the family deductible is met, your insurance will pay benefits for all covered family members.
The annual deductible doesn’t include amounts taken out of your paycheck for health coverage.
Silver has a "true family deductible". This means that the entire family deductible must be met before your insurance will pay benefits for any covered family members.
There is no “individual deductible” in the Silver coverage level when you have family coverage. So even if only one person in your family has a lot of expenses, the full family deductible must be met before insurance will begin to pay its portion of benefits.
The annual deductible doesn’t include amounts taken out of your paycheck for health coverage. Also, copays for certain medical benefits may not apply towards the annual deductible.
The Platinum coverage level does not have an in-network deductible. Keep in mind that as a trade-off for no deductible, the Platinum coverage level is usually the most expensive coverage level per paycheck.
Do You Use Out-of-Network Providers?
Out-of-network charges will not count toward your in-network deductible or out-of-pocket maximum. The same goes for in-network charges—they will not count toward your out-of-network deductible or out-of-pocket maximum.
Some insurance carriers in CA, CO, DC, GA, MD, OR, VA, and WA, do not cover out-of-network benefits at all.
