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How Deductibles Work

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.

It Depends on Your Medical Coverage Level

Bronze, Gold, and Platinum have a traditional deductible.

Once a covered family member meets the individual deductible, your insurance will begin paying benefits for 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.

Bronze Plus and Silver have 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 Bronze Plus and Silver coverage levels when you have family coverage. So even if one person in your family has a lot of expenses, you’ll have to pay for it on your own until the full family deductible is met.

The annual deductible doesn’t include amounts taken out of your paycheck for health coverage.

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.

And some insurance carriers in CA, CO, DC, GA, MD, OR, VA, and WA do not cover out-of-network benefits at all.


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