Health Insurance 101: What Does It Mean if a Deductible Is Waived?

Your health insurance deductible can help you save money on out-of-pocket costs. When you pay for healthcare services, it might be comforting to know that you are putting money toward reaching your deductible. Once you reach your deductible, most of the other on-plan healthcare costs should be primarily covered by your health insurance plan. 

However, if you see “deductible waived” on your medical services claim or bill, it’s not necessarily time to jump for joy.

What is a health insurance deductible?

To recap: Your deductible is the amount you pay for medical expenses before your insurance covers the bulk of the costs. Before you reach your deductible for the year, you may have to pay the full cost out of pocket for certain health services. 

In other words, after you reach your deductible, you may only pay a fraction of the cost for services, and your insurer may cover the rest. 

What does it mean if a deductible is waived?

Here’s the thing: Not all medical costs will count toward your deductible. In these cases, you may see certain services on your plan that say “deductible waived” or “deductible does not apply.”

This means you’ll pay the expense, but the payment won’t get you closer to reaching your deductible. 

In some cases, the deductible may be waived because the service is already free or at a low cost under your plan. This is often the case with preventive services. For example, an annual wellness visit may only cost you $20, but that $20 might not count toward your deductible.

When might a deductible be waived? 

An expense may not count toward your deductible if the service:

1. Wasn’t covered by your plan

2. Was performed by an out-of-network provider

3. Did not receive prior authorization, or it was authorized but wasn’t received within the given time limit

4. And/or was a preventative service that your insurer provides for free or low cost

You can always call your insurance representative before receiving a medical service to check whether a payment will chip away at your deductible or not.  You can also call your provider to understand what the costs may be to you.  Even if you can’t change the outcome, you’ll feel better prepared to budget for the rest of your year, knowing what will have to come out-of-pocket. 

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Written by:

Hilary Weissman

Hilary Weissman has been a health writer for the past 6 years. She was a senior copywriter at WW (Weight Watchers) before joining GoodRx and was also a copy editor in S&P Global’s structured finance ratings group for 3 years prior.

Reviewed by:

Alexandra Schwarz, MD

Alexandra Schwarz, MD, is a board-eligible sleep medicine physician and a board-certified family medicine physician. She is a member of both the AASM and the ABFM.

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