Deductibles and your Marketplace health insurance

By | January 4, 2016

To find the health plan on the market that works best for your family, consider different factors, such as the premium, the annual deductible, what services are covered and other details. While premiums may often be a decisive factor, other considerations might be so important.

Let’s look: the deductible.┬áThe deductible is the amount that should be paid by the health care services that your plan covers until it begins to pay.


5 things you should know about deductibles in the market plans:

  • All the market plans cover preventive services recommended no deductible. Services such as the detection of cancer, vaccines, and well-child visits will be covered without having to pay the deductible, copayments or other costs for you.
  • Many other health services are often covered without a deductible. Many health insurance plans offer some benefits before you pay the deductible. In these plans, it is possible that you can visit to your primary care physician or receive a prescription for a generic drug and only pay a co-pay. Even visits to specialists, outpatient mental health and brand-name drugs are often covered no deductible, you will still be responsible for copayment or coinsurance.
  • See what your plan covers without deductible. Plans differ in what they cover. When you find a plan that you like online, watch “cost of care” to see which services are deductible and which not. You can also click on the “summary of benefits and coverage” of the plan to see a detailed explanation of how the plan deductible applies to the different services, and see examples for certain types of care.
  • Consider the services covered no deductibles along with other out-of-pocket costs when choosing the plan that suits you. It is important to understand what your insurance company covers without having to pay the deductible. Then you can decide if a plan with lower monthly premiums and a deductible higher, or one with a higher monthly premium and a deductible lower. When you see the overview of medical 2016 plans, you will see an estimate of the total of their out-of-pocket expenses, including deductibles and co-payments, to help you make this decision.
  • Silver plans can do so to save more. If you qualify for the reduction of cost-sharing – as the majority of consumers who enroll in the policies of the market – you can save more. A family of 4 with income below $60,625 may qualify for additional savings with lower co-payments, deductible lower, and most services covered no deductible at all. This financial assistance is only available if you purchase a plan silver; so while a plan silver can have monthly premiums higher than some other plan options, be sure to consider your total costs. If you meet the requirements, the annual maximum out-of-pocket costs could be reduced by thousands of dollars, and your deductible could be reduced also. Check to see if you qualify for these savings.