Understanding your health insurance benefits is important for being a well-informed consumer. One of many details of your plan that you should review is your deductible. Your deductible is the annual amount you must pay each year for specific non-copay health care services before your insurance begins to pay. For example, if you have a $2,000 deductible, you will pay $2,000 for health care services before your insurance kicks in. Generally, your deductible starts over every year in January, but you should check your specific plan to verify.
Deductibles can be confusing, so we have rounded up the most frequently asked questions we receive about health insurance deductibles:
What is the difference between a plan year deductible and an annual deductible?
An annual deductible runs by calendar year (January 1 through December 31) while a plan year deductible follows your plan’s renewal date. For example, if your renewal is in June, your plan year deductible would run June 1 through May 31 every year.
Will any of my deductible rollover to the new year?
Most plans no longer offer fourth-quarter carryover. However please check your certificate of coverage to see the guidelines from your plan.
What is the difference between an embedded deductible and an aggregate deductible?
For an embedded deductible, only one family member needs to meet their individual deductible. If their individual deductible is met, then the health insurance carrier will start to pay the coinsurance of the entire plan. For an aggregate deductible on coverage with more than one person, the entire family deductible must be met before the health insurance carrier begins to pay.
What happens once my deductible is met?
Once you have met your deductible, any in-network benefits would be paid by your health insurance carrier at the coinsurance level of the health plan for the remainder of the deductible year.
Do I have to pay my annual deductible upfront to the health provider?
Deductible charges are charged to patient as they are accrued. If you have a surgery, for example, your provider (i.e., the doctor or hospital) will contact the health insurance carrier and check to see how much deductible is remaining on your plan and may ask you to pay your portion of your deductible and coinsurance that are remaining at the time of the benefits check. Most providers will allow you to setup up a payment schedule if you cannot afford to pay the entire deductible at one time.
Your ARC representatives are available to walk you through your plan and what it means. Give us a call today to set up an appointment!