A: A deductible is a dollar amount of health care charges stated in the plan design that you pay out of pocket (or self-insure) each year, BEFORE the insurance company starts paying health care providers for your claims. A deductible gives you some control over the monthly premium charged by the health insurance company.
If you select an annual deductible amount of $1000, in simple terms that means you are telling the health insurance company to lower its premium cost that you must pay every month, because you will be paying for claims out of your pocket up to $1000 for the year. (Of course, you won’t have out-of-pocket cost for any wellness and preventative care claims covered by your health plan.) But you still get the benefit of having the insurance company process any claim amounts you may have under your deductible based on the carrier’s discounted contract prices to your health care providers, instead of paying providers high retail charges for out-of-network or uninsured claims. Most importantly, you have health insurance in place for the major claims that could happen.
Only the most expensive health insurance plans provide “first-dollar” coverage and DO NOT have a deductible. Look at it this way: If the deductible is zero, that means you are asking the health insurance company to pay ALL claims you incur with your health care providers each year. Such a plan would come at a very high monthly premium cost. Most individuals and small businesses cannot afford complete first-dollar coverage. That is, unless someone else is paying the lion’s share of the premium, such as a large private employer, union or government entity. Low-income households may qualify for federal premium tax credits on Affordable Care Act individual health plans purchased on the exchanges.
So, when selecting your medical plan, it is important to compare the trade-off between the monthly premium you pay to the insurance company, regardless of whether or not you have any claims, and your deductible and the plan limits on your annual out-of-pocket costs if you do have claims during the year.
The trend of health insurers is to offer more health plans with low or without deductibles, reflecting a broad shift toward consumer-centric healthcare. New research has shown that by eliminating deductibles, these plans can significantly enhance health outcomes, particularly for individuals with chronic conditions and severe complications by providing wellness and first-dollar coverage.
Our national private exchange identifies the top-rated carriers in each state and what we believe are their highest value plans. Each year, health plans continue to change benefits and carriers must re-file their plans to meet state and federal requirements, including premium rates, county by county.
Under federal rules, premium costs for Qualified Comprehensive Major Medical plans vary by your age, your residence location, how many family members are covered, tobacco use, the insurance carrier and the plan design (“metal tier” governing your deductible, copays and out-of-pocket costs: Bronze, Silver, Gold, Platinum), but not health status.
Federal rules for Qualified individual medical insurance plans require coverage of most preventive care, free with no deductible. For example, there are many preventive-care services provided specifically for women under the law. The editors of Health list them as including mammograms, cervical cancer screenings and well-woman visits. Other covered preventive care services include blood pressure, diabetes, depression and cholesterol screenings for adults, and vaccines and well visits for children. You pay nothing for these services – no deductible, copay or coinsurance. Knowing preventive care is covered outside your plan’s deductible makes it much more acceptable to select a plan with a higher deductible to get your monthly premium cost down.
Health Savings Account (HSA) Plans – A smart budgeting strategy is to build up a savings account equal to your deductible, so you can draw on it if needed. That is why the Federal government in 2004 put tax incentives in place for you if you set up an HSA health plan with a bank account that coordinates with a qualifying health insurance plan and meets IRS guidelines for the plan’s annual deductible and out-of-pocket maximum. Deposits to the HSA account are dollars you pay to yourself, not to the insurance company, and are tax-deductible (IRS publishes limits each year). Even better, your unused HSA deposits roll over each year, ready to be used in the future as needed, all the way into retirement.
The Benefit Program for Authorized U-Haul Dealers features a comparison-shopping tool makes it easy find out in hard dollars how controlling the amount of your deductible will impact the monthly premium you pay for health insurance. HSA health plans are offered where they are approved by state insurance authorities.