Deductible
The amount a patient pays for covered services each plan year before the health plan begins to share the cost.
Updated
A deductible is the dollar amount a patient must pay out of pocket for covered health care services each plan year before the insurance plan begins to pay its share of the cost.
Some services, such as preventive care, may be covered before the deductible is met, depending on the plan. Once the deductible is satisfied, the patient typically moves to coinsurance or copayments until reaching the out-of-pocket maximum.
In practice
In medical billing, deductibles are tracked against the allowed amount for services rendered. Claims processed while the deductible is unmet show a patient-responsibility balance, and providers collect that amount from the patient rather than from the payer.
Commonly confused with
- Coinsurance: Coinsurance is a percentage of cost paid after the deductible is met; the deductible is a fixed amount paid before the plan begins to share cost.
- Copayment: A copayment is a fixed dollar amount due per service, often independent of whether the deductible has been met.