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Do I have to meet the family deductible before my health insurance starts paying anything?

Related Topics: Insurance, Family

Answers From Experts & Organizations (1)

Health Reform
924 Answers
893 Helpful Votes

The short answer is: it depends. The type of plan you have, as well as how your employer (assuming you get your insurance through work) has structured benefits, will impact how your deductible is met.

According to Michael Thompson, of PricewaterhouseCoopers’ Health and Welfare Practice, most plans have an individual and a family deductible. Satisfying your deductible generally works like this:

PPOs and Deductibles

With a traditional PPO-style plan (preferred provider organization), if one person in your family meets his or her individual deductible, benefits will kick in for that person. “Under the traditional PPO approach, the individual would be in benefit even though the family deductible has not yet been met,” Thompson says.

In any case, you won’t pay more than the total family deductible before insurance begins to pick up the bill for care, meaning if you have five members in your family, each member won’t need to meet the individual deductible.

High-Deductible Plans

It’s a different story with high deductible, HSA-qualified plans. In these arrangements, if you’re covering a family, it’s the larger family deductible (as opposed to the individual deductible) that must be met in order for your benefits to take effect. “If you have a $1,500 individual deductible and a $3,000 family deductible, the plan won’t pay any expenses before the aggregate expenses of the family exceed $3,000,” Thompson says.

In some cases, Thompson says, employers offering health insurance may elect to treat their deductibles the same with all plan types,which is why you always need to check to be certain how your benefits operate to avoid expenses you didn’t plan for.

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Read the Original Article: Understanding How Your Deductible Works