Key takeaways:
A health insurance deductible is what you pay before your plan begins cost-sharing for covered services.
Some health insurance plans have a separate deductible for prescription drug coverage.
All Affordable Care Act (ACA) plans and most other types of health insurance pay the entire cost of some preventive services, even if you haven’t yet met your deductible.
You and your health insurance share the cost of your medical care in various ways. One common method is by including a deductible in your health insurance plan design.
To manage your healthcare costs, it’s important to understand what deductibles are and how they figure into what you pay when accessing care. Here’s an overview to get you started.
What is a deductible?
A deductible is the amount of money you must pay before your insurance plan begins cost-sharing for covered services. The plan won’t pay any claims until you’ve spent the deductible amount. After that, you begin cost-sharing with your insurer under the terms of your plan. The policy may require copayments (copays) and coinsurance until you reach your out-of-pocket maximum, after which your plan will pay for 100% of covered benefits through the end of the year.
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There’s one caveat on your plan paying claims before you reach your deductible: For most policies, deductibles are waived for certain preventive services, such as annual exams and certain screenings. And when you access this preventive care with in-network healthcare professionals and facilities, it’s covered at 100%
How deductibles work
As your plan year begins, you pay 100% of your healthcare charges until your out-of-pocket total for covered services equals, or “meets,” your deductible. The insurer then begins cost-sharing for covered services through the end of the plan year. You may still have copays and coinsurance until you meet your plan’s annual out-of-pocket maximum.
Deductibles and out-of-pocket maximums reset once a year. For Affordable Care Act (ACA) plans and most other health insurance, the reset date is January 1 annually.
Do all healthcare insurance policies have deductibles?
Most do. You should expect deductibles on these types of health insurance:
Medicaid, in some cases
Qualified health plan (QHP), such as employer-sponsored or from an ACA marketplace
The higher the deductible, the more you’ll have to pay out of pocket before plan cost-sharing starts. As a result, your policy is less likely to deliver significant value during a plan year. That is why a high-deductible health plan (HDHP) has a lower monthly premium compared with other types of health insurance.
There are also health plans with an upfront cost of $0, called no-deductible or zero-deductible plans. With this coverage, the insurance company starts paying your claims right away. However, you pay higher monthly premiums and still share costs through copays and coinsurance when you access care. You may also have tight network restrictions on the facilities and healthcare professionals you can see for covered services.
Veterans Affairs (VA) healthcare doesn’t have deductibles, but it does have a series of potential copays for services.
What are the different types of deductibles in health insurance?
You’ll see various types of deductibles when looking at your policy or comparing plans. Here are some of the most common:
In-network and out-of-network deductibles: In-network deductibles apply to healthcare professionals and facilities covered by your plan. For care you get outside of the plan’s network, you incur a higher deductible as well as higher copays and coinsurance amounts.
Individual and family deductibles: Some plans have a deductible for each covered individual, and some policies have an aggregate or family deductible for everyone covered by the plan. For an aggregate deductible, out-of-pocket costs for everyone count toward the family out-of-pocket target.
Embedded deductible: With this type of family deductible, each covered person has an individual deductible, while the group also has a collective deductible. Each person gets their benefits as soon as they meet their individual deductible, despite the status of the family deductible. Once the family deductible has been met, the insurer pays claims for all members.
Prescription drug deductible: Some insurance plans have a separate deductible for prescription coverage. The deductible may or may not apply to all the medications covered by your plan.
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How much are deductibles?
Deductible amounts vary by plan, but here are some numbers to consider:
For QHPs, which includes most commercial plans, the 2026 maximum deductible amounts are $10,600 for individual coverage and $21,200 for family plans.
Among employer-based health insurance plans in the U.S., the average deductible in 2025 for workers with a general annual deductible was $1,886 for singles and ranged from $3,118 to $5,095 per family based on plan type.
Average deductibles for ACA marketplace plans hit record highs in 2026 with an average of $3,786 for all except platinum and catastrophic plans. The average was $7,476 for bronze plans, $5,304 for silver plans (without cost-sharing reductions that lower deductibles and other out-of-pocket costs), and $1,722 for gold plans.
Is it better to have a high or low deductible?
An HDHP may be better for a person who rarely needs care and wants lower monthly premiums. This is an option for many people who may have considered dropping health insurance but want protection from large, surprise medical expenses. (ACA bronze and catastrophic plans are now considered HDHPs.)
At the same time, an HDHP has risks. For example, if you end up in the hospital unexpectedly or need costly treatment, you may not have enough funds to cover the high deductible. This could leave you with medical debt. However, some employer-based HDHPs include a health savings account (HSA). An HSA lets you and your employer contribute pretax dollars reserved for medical costs not covered by the HDHP. Because you don’t pay taxes on this money, it can help your healthcare dollars go further when there are qualified medical expenses. The money also rolls over year to year and grows with interest. An HSA also has portability, which means the account belongs to you even if you leave the job.
If you fear sudden strains on your budget, managing your expenses with a low-deductible or zero-deductible plan may suit you better. You’ll pay a higher monthly premium, but you may find you save money overall. That’s especially true if you already know you’re likely to require frequent healthcare services.
Do my monthly health insurance payments go toward my deductible?
No. Your monthly payments are your health insurance premiums. They are similar to a subscription that gives you access to services. You pay your deductible in addition to your premiums.
How different factors work with your deductible
Your deductible is one part of your cost-sharing obligation. Before and after it’s met, you still have various out-of-pocket expenses related to having a plan and accessing care. The three main nondeductible costs are:
Insurance premiums: As mentioned, higher deductibles are linked to lower premiums. Similarly, lower deductibles typically pair with higher monthly premiums.
Copays and coinsurance: These cost-sharing charges may be required before and after you meet your deductible until you reach your out-of-pocket maximum. Copays are flat fees for covered health services, such as $30 for a doctor’s visit. Coinsurance is the percentage of the medical bill you’re responsible for paying. For example, with 20% coinsurance, you’d owe $20 for a $100 doctor’s office visit. Your plan documents will have specific information on when these charges apply.
Out-of-pocket maximum: This figure represents the annual limit of what you’ll owe for covered healthcare treatments and services. Beyond that amount, the insurer pays for 100% of covered services. Deductibles count toward your out-of-pocket maximum, as do all payments you make for covered health services. In tandem with your deductible, your progress toward your out-of-pocket maximum resets to $0 when the new plan year starts.
Does a job change affect your deductible?
When you switch or leave a job, the effect on your deductible depends on the source of your insurance coverage. If you have an employer-based plan, any deductible contributions you’ve made will not carry over to the new employer’s plan. Your plan stays the same and your deductible contributions are unaffected if you purchased your coverage:
Through the ACA marketplace
Direct from the insurer
Through an insurance agent or broker
When can your deductible be waived?
All ACA plans exclude a group of preventive benefits from the deductible, such as certain screenings and immunizations. That means you can receive the plan benefit at no cost from in-network healthcare professionals and facilities, whether or not you’ve met your deductible.
Your plan’s summary of benefits and coverage will explain care that doesn’t require you to meet or pay toward your deductible.
What can you do if you can’t afford your deductible?
Before you face an unaffordable deductible, one smart move is to have a savings account that can help you cover healthcare expenses. You may qualify for an HSA if you have an HDHP.
You may need to meet your deductible right away. If you decide to pay by standard credit card or medical credit card, see if it’s possible to use one that offers an introductory 0% annual percentage rate (APR). Some cards allow you to set up low-APR installment plans to pay off large purchases.
Another way to plan ahead for a deductible is to buy supplemental or alternative insurance, such as fixed-indemnity or accident insurance. This type of plan pays you a lump sum for a specified medical event. The cash can help you pay out-of-pocket healthcare expenses, including your deductible. In considering this option, compare the plan’s premium cost to your deductible amount and your available savings.
Medigap supplement insurance
If you have Original Medicare (Part A and Part B), you can have a Medigap plan, which is also called Medicare supplement insurance. You can choose from various Medigap plans, which can help you pay for some or all of your out-of-pocket costs for Part A and/or Part B covered services. It’s important to note that you can’t get Medigap supplement insurance with a Medicare Advantage plan.
Can GoodRx purchases be credited toward your deductible?
If you use a GoodRx coupon to purchase a medication covered by your plan, you can submit your receipt to your insurance company and ask for the expense to count toward your deductible. This request may be denied, but you should ask a health plan representative about submitting this information for credit toward your deductible.
GoodRx Companion
GoodRx Companion is a subscription plan that offers savings on prescriptions, telehealth, and other everyday healthcare services — such as dental, vision, imaging, and lab work — for a low monthly price. This program gives you access to more than 250 medications at no additional cost and hundreds more for less than $10 per fill.
Frequently asked questions
A deductible is how much you need to pay toward covered expenses before your insurer starts helping with any costs. One exception: certain preventive health services, which your insurer covers in full regardless of whether you’ve met your deductible.
Your copay is a fixed fee you pay for specific services, such as routine doctor visits and prescription drugs. Your copay amounts are usually printed on your insurance card or can be found in your plan’s summary of benefits and coverage.
A no-deductible or zero-deductible plan means you don’t have to pay anything out of pocket before your insurer starts cost-sharing for covered services. However, you may still have to pay copays and coinsurance until you meet your plan’s out-of-pocket maximum.
In 2026, a high-deductible health plan (HDHP) has a minimum deductible of $1,700 for individuals and $3,400 for families. Annual out-of-pocket spending maximums for HDHPs in 2026 are capped at $8,500 for individuals and $17,000 for families.
A deductible is how much you need to pay toward covered expenses before your insurer starts helping with any costs. One exception: certain preventive health services, which your insurer covers in full regardless of whether you’ve met your deductible.
Your copay is a fixed fee you pay for specific services, such as routine doctor visits and prescription drugs. Your copay amounts are usually printed on your insurance card or can be found in your plan’s summary of benefits and coverage.
A no-deductible or zero-deductible plan means you don’t have to pay anything out of pocket before your insurer starts cost-sharing for covered services. However, you may still have to pay copays and coinsurance until you meet your plan’s out-of-pocket maximum.
In 2026, a high-deductible health plan (HDHP) has a minimum deductible of $1,700 for individuals and $3,400 for families. Annual out-of-pocket spending maximums for HDHPs in 2026 are capped at $8,500 for individuals and $17,000 for families.
The bottom line
Deductibles are a cost-sharing feature of almost every health insurance plan. Plans may impose different deductibles depending on the care you access. For example, most commercial plans waive the deductible for certain preventive care services and often have a separate prescription plan deductible that applies when you need medications. If you have a high-deductible health plan (HDHP), adding a health savings account (HSA) may help you manage out-of-pocket expenses.
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References
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