What is a Deductible and When is it Due to be Paid?

Deductible Health Insurance Plans are a good way to lower your premium and make healthcare more affordable. They are not for everyone. It is, however, worth considering if you are medically low maintenance, looking for a catastrophic plan, need insurance while you’re in-between jobs, or if you now find yourself having to pay for your own health benefits. If affordability is of key importance, then deductible medical insurance coverage may be right for you.

Kaiser Permanente offers a variety of deductible plans where doctor visits and prescription drugs are not subject to the deductible. For services other than office visits or drugs, the deductible would apply. A deductible means you will pay 100% of the medical expenses until what you’ve paid for health services adds up to the amount of the deductible. At that point, the insurance will “kick in”. Depending on the plan, you may or may not need to pay additional fees, but if you do, they will be at discounted rates. You continue to pay these copayments until you reach the maximum out-of-pocket amount. Then, subsequent services are free until the end of the calendar year. The average member does not reach their deductible, much less the maximum out-of-pocket amount. You’re likely to reach the maximum if there is a major medical incident.

The Three Stage of Deductible Medical Insurance Coverage

Kaiser offers standard deductible health insurance plans and HDHP (High Deductible Health Plans) with HSA. Under most of the standard deductible plans, office visits and drugs are not subject to the deductible; you pay discounted copayments right from the get-go. This makes a standard HMO deductible plan an attractive choice, especially for children or anyone who wants the peace of mind of knowing you have low copayments for Rx and physician visits. These plans allow you to obtain coverage for the most frequently needed services, while paying reduced premiums. Under the HSA plans, all services are subject to the deductible, including doctor visits. An exception would be preventive care services, which are free. HSA’s may be a better fit if you want the advantage of being able to open a health savings bank account, which is optional.

Whichever deductible plan you might enroll for, it is helpful to know that if you need a medical service that is subject to the deductible, that visit does not automatically cost whatever the amount of the deductible is. For example, if you have lab work done that costs $100 and you are on the $30/1500 HMO Deductible Plan, you will simply be charged the $100 fee, not the $1500 deductible amount. The $100 you pay will go towards the $1500 deductible. Charges will be accumulated as you go, until the deductible amount is met.

Given Kaiser Permanente’s range of medical plans that carry varying deductible sizes, it is encouraging to know you don’t have to compromise quality of care to make it fit your budget.

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