6 things to know about deductibles in the Health Insurance Marketplace®

Published on January 28, 2014

Deductibles, premiums, copayments, and coinsurance, are important for you to consider when choosing a health insurance plan. You can compare health plans and see if you qualify for lower costs before you apply. Most people who apply will be eligible for help paying for health coverage.

Here are 6 important things to know about deductibles:

1. Having health insurance can lower your costs even when you have to pay out of pocket to meet your deductible. Insurance companies negotiate their rates with providers and you’ll pay that discounted rate. People without insurance pay, on average, twice as much for care.
2. A health insurance deductible is different from other types of deductibles. Unlike auto, renters, or homeowners insurance, where you don’t get services until you pay your deductible, many health insurance plans provide some benefits before you meet the deductible.
3. All Marketplace plans cover preventive care. Screenings, immunizations, and other preventive services are covered without requiring you to pay your deductible. Many health insurance plans also cover other benefits like doctor visits and prescription drugs even if you haven’t met your deductible.
4. In 2014, there’s a $6,350 maximum for individual
   out-of-pocket costs

   Your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

   for in-network services. The maximum for families is $12,700. Even if you choose a high deductible catastrophic plan, your out-of-pocket costs should not exceed this limit.
5. Over 70% of Marketplace plans have deductibles under $3,000. When you choose a health insurance plan, it’s important to understand what your insurance company covers without requiring you to pay your deductible. Then you can decide whether you want a plan with lower monthly premiums and a higher deductible, or one with a higher monthly premium and a lower deductible.
6. Silver plans can save you more. If you qualify for lower out-of-pocket costs and choose a Silver plan, you can save more with a lower copay and a lower deductible. If you qualify, you'll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but these out-of-pocket savings apply only if you enroll in a Silver plan.