A health insurance deductible is the amount you must pay for covered medical services before your insurance plan begins to share costs. If your deductible is $2,000, you pay the first $2,000 of covered services yourself. After you meet that threshold, your insurer starts covering a portion of your costs, though you may still be required to pay the provider some amount in the form of coinsurance or copays.
Deductibles reset every plan year, typically on January 1 for individual plans or on your employer's renewal date for group plans.
How does a deductible work?
Here's a basic example. You have a plan with a $1,500 deductible and 20% coinsurance for urgent care and imaging services and a $60 copay for specialists visits.
You visit an urgent care clinic in March. The bill is $400. You pay the full $400 because you haven't met your deductible yet. The plan pays $0. Your deductible balance is now $1,100.
In June, you need an MRI. The negotiated rate with your insurer is $1,200. You pay the remaining $1,100 of your deductible, plus 20% coinsurance of the $100 left over. Your total out-of-pocket cost is $1,120. Your deductible is now met.
In September, you see a specialist. The visit costs $300. You pay only a $60 copay. Your insurer covers the rest.
When do you pay for services if your plan has a deductible?
You pay the full cost of every covered service you receive until you've reached your full deductible amount.
Most plans require you to meet your deductible before they pay for services like specialist visits, imaging, surgery, or hospital stays. However, some plans cover certain services before the deductible is met. Primary care visits, generic prescriptions, or urgent care may have a flat copay regardless of whether you've met your deductible.
Preventive care is always covered at no cost under ACA-compliant plans, even if you haven't met your deductible. This includes annual checkups, screenings, and vaccines.
Common deductible amounts
Individual plan deductibles typically range from $1,000 to $7,000, depending on the plan type and metal tier. Family deductibles are usually double the individual amount or operate as an aggregate threshold.
High-deductible health plans (HDHPs) must meet IRS minimums to qualify for HSA eligibility. For 2026, that's $1,700 for individual coverage and $3,400for family coverage.
Plans with lower monthly premiums usually have higher deductibles. Plans with higher premiums tend to have lower deductibles. The tradeoff depends on how much care you expect to use during the year.
Deductible vs. copay vs. coinsurance
These terms describe different ways you share costs with your insurer.
A deductible is the total amount you must pay for provider costs before your insurance starts paying for covered services.
A copay is a fixed amount you pay for a specific service, like $30 for a doctor visit. Copays may or may not count toward your deductible, depending on your plan.
Coinsurance is the percentage you pay after meeting your deductible. If your plan has 20% coinsurance for a covered service, you pay 20% of the cost and your insurer pays 80%.
All three can apply to the same plan. You might have an overall deductible, a copay for prescriptions, and coinsurance for outpatient surgery.
Do all services count toward your deductible?
No. Only costs for covered services count toward your deductible. If you visit an out-of-network provider and your plan doesn't cover out-of-network care, that spending won't count.
Preventive care doesn't count toward your deductible because it's covered at no cost under the ACA. Premium payments also don't count.
Some services, like office visits or prescriptions, may be covered with a copay before you meet your deductible. Whether that copay counts toward your deductible depends on how your plan is structured. Check your summary of benefits to confirm.
Understanding your deductible is part of choosing the right plan for you
Your deductible is one part of your total out-of-pocket costs, which also include copays, coinsurance, and premiums. Plans with lower deductibles cost more upfront but may reduce the amount you’ll need to pay if you need significant care. Plans with higher deductibles cost less per month but require more cash flow if something happens.
Understanding how your deductible works helps you estimate costs and make better decisions during open enrollment. Read your plan documents carefully and know which services are covered before you meet your deductible.
