What Happens When I Meet My Deductible?

When you meet your deductible, your health insurance plan transitions to a new phase where it starts to cost-share a larger portion of your medical expenses. Here’s what typically happens next:

• Coinsurance Kicks In:  After satisfying your deductible, you enter the cost-sharing phase. Coinsurance is the percentage of medical costs that you share with your insurance company.
• Fixed Copays for Services: Some services may require copayments, which are fixed amounts you may pay at the time of service to the provider. Depending on your plan your copay may not apply until after your deductible has been satisfied, or the copay may be all that you pay if your plan indicates that the deductible does not apply. Copays do not accumulate toward your deductible but do accumulate toward your out-of-pocket maximum.
• Reaching the Out-of-Pocket Maximum: Out-of-Pocket Maximum is the total amount you will pay in a calendar year, or plan year for covered services. It includes your deductible, coinsurance, and copays. Once you reach this limit, your insurance covers 100% of your covered medical expenses for the remainder of the year.