Key takeaways:
After you meet your deductible, your health insurance plan helps you pay for covered services. Examples include prescription refills and mental health therapy.
Most health insurance plans cover preventive care services, like mammograms and immunizations, before you meet your deductible.
Check with your insurance provider to learn more about your annual deductible and determine which services your plan covers.
Save on related medications
Meeting your health insurance deductible means you’ve paid enough out of pocket for your plan to start sharing the cost of your care. Most health insurance plans cover preventive care services — such as immunizations, mammograms, and colonoscopies — regardless of whether you’ve met your annual deductible. Your deductible depends on your specific plan. But once you’ve paid your deductible, your insurance will help you pay for additional medical services.
For example, if you have a $3,000 deductible, you’ll pay the first $3,000 worth of medical expenses before your insurance plan kicks in. After meeting your deductible, you’ll have access to several medical services for a much lower out-of-pocket amount. This is because you’ll have to pay copays or coinsurance only.
How health insurance works after you meet your deductible
If you’ve met your annual health insurance deductible, you may be wondering, “Now what?”
After you meet your deductible, your insurance will help you pay for covered healthcare services. But you may have to pay coinsurance or copays, depending on your health plan.
Coinsurance is a percentage of the costs you are responsible for paying out of pocket for services after you meet your deductible. In this scenario, your insurance company covers the remaining portion of the costs.
For example, if you have a 20% coinsurance and a medical service costs $2,000, you would be responsible for paying $400. Your insurance company would cover the remaining $1,600.
A copay is a fixed amount that you pay for services before or after you meet your deductible. For instance, you may have a $10 copay for generic prescription medications or a $20 copay for visits with a healthcare professional.
Using your health insurance after you’ve met your deductible
Here are nine ways to take advantage of your healthcare benefits after you meet your deductible and before it resets.
1. Dermatology visits
If you have a family history of skin cancer or something abnormal you want checked, visit a dermatologist after your deductible is met. A once-a-year skin check with a specialist is a way to help prevent melanoma or another skin cancer.
Wondering how deductibles work? Here’s what you should know about deductibles for health insurance.
Do you have a health savings account (HSA)? An HSA can help you pay for these qualified medical expenses if insurance doesn’t cover them.
Considering a high-deductible health plan (HDHP)? An HDHP may qualify you to contribute to a HSA, but here are pros and cons to consider.
Note: If you have an immediate concern about your skin, such as a spreading rash or a painful mole, you should see a dermatologist as soon as possible.
2. Elective surgeries
Many people have bunion or hammertoe surgeries, meniscus repairs, and frozen shoulder surgeries at the end of the year. This is typically when people have met their deductible and know it’s more likely that their insurance company will help pay for elective surgery.
Other elective procedures that may be more affordable at the end of the year when you’ve met your deductible include:
Anti-reflux surgery
Joint replacement surgery
Eye surgery
Hernia surgery
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Most insurance plans cover elective surgeries that are deemed medically necessary.
3. Imaging, lab work, and diagnostic testing
X-rays, blood work, and ultrasounds that are not for preventive care may cost less after you meet your deductible. For example, maybe a healthcare professional wants you to have an ultrasound to check for arthritis or a blood test for iron-deficiency anemia. Waiting till the end of the year might be a good way to save money.
But if you have an immediate need, don’t put off procedures until after you’ve met your deductible.
4. Physical therapy
If you need physical therapy for pain or an injury, you may pay less for your visits once your deductible is met. But this may be helpful only up to a point because you may have a cap on the number of appointments you’re allowed each year. For example, if you get 30 visits a year and reach your deductible after your 25th appointment, only five visits are eligible for physical therapy benefits.
5. Injections
If you receive injections such as Prolia (denosumab) for osteoporosis, medroxyprogesterone (Depo-Provera) for contraception, testosterone, or vitamin B12 — and you’re billed for every injection — meeting your deductible may help lower the costs.
Corticosteroid injections for pain and inflammation and orthobiologic injections that promote healing may also be covered at a reduced rate. But a healthcare professional may limit you to three or four corticosteroid injections a year.
6. Specialist visits
Has a healthcare professional referred you to a cardiologist, a gastroenterologist, or an endocrinologist for a persistent issue? If you’ve been delaying a visit to a specialist because you’re worried about the cost, try to see them before the end of the year, after you reach your deductible. Specialists can be costly if they recommend tests and complex procedures to treat a condition.
7. Medical equipment
Do you need a new CPAP (continuous positive airway pressure) machine or a blood sugar monitor? Replacing medical equipment after you meet your annual deductible can save you money. And you can plan ahead for items that regularly need to be upgraded, like knee braces, infusion pumps and supplies, and oxygen equipment and accessories.
8. Prescription medication refills
After you reach your deductible, see if you can fill your prescriptions for the rest of the year. You may be able to get a 90-day supply of your medications if your insurance allows it. You’ll save money and be prepared for an emergency or a loss of coverage.
9. Mental health therapy
Mental health services are one of the 10 essential health benefits that all Affordable Care Act (ACA) plans must cover. Check with your specific health plan to see if your mental health needs are fully or partially covered. A therapy session can cost anywhere from $65 to over $250 without insurance.
Keep in mind that you may need to get a mental health diagnosis before your plan covers these services.
What services are covered before you meet your deductible?
ACA plans and most other health plans must cover preventive care services at no cost to you. Even if you haven’t reached your annual deductible, you can typically get access to the following services for free through an in-network provider:
Blood pressure screening
Depression screening
Diet counseling for high-risk individuals
Immunizations (influenza, hepatitis A, hepatitis B, and more)
Pap smears for women ages 21 to 65
Type 2 diabetes screening for qualified adults ages 40 to 70
Urinary incontinence screening for women
Well-woman visits
Frequently asked questions
You meet your deductible by paying out of pocket for covered medical expenses, such as visits to a healthcare professional or lab tests. Each time you pay for one of these, it counts toward your deductible. Once you reach the full amount set by your plan, your insurance starts covering more of the costs.
Your insurance deductible usually resets once a year, often on January 1. This means you start over and must meet your deductible again for the new plan year. Some employers or plans may follow a different 12-month cycle, so it’s a good idea to check your plan details.
Covered medical expenses under your health insurance plan count toward your deductible. This means that hospital stays, diagnostic services, and prescription medications (if your plan covers them) will apply to your deductible. But expenses for services not covered by your plan, including cosmetic procedures or out-of-network care that’s excluded from coverage, typically do not count toward your deductible.
You meet your deductible by paying out of pocket for covered medical expenses, such as visits to a healthcare professional or lab tests. Each time you pay for one of these, it counts toward your deductible. Once you reach the full amount set by your plan, your insurance starts covering more of the costs.
Your insurance deductible usually resets once a year, often on January 1. This means you start over and must meet your deductible again for the new plan year. Some employers or plans may follow a different 12-month cycle, so it’s a good idea to check your plan details.
Covered medical expenses under your health insurance plan count toward your deductible. This means that hospital stays, diagnostic services, and prescription medications (if your plan covers them) will apply to your deductible. But expenses for services not covered by your plan, including cosmetic procedures or out-of-network care that’s excluded from coverage, typically do not count toward your deductible.
The bottom line
Most health insurance plans cover preventive care services like mammograms and Pap smears before you meet your deductible. After you reach your deductible, your health insurance will help you pay for covered services, like prescription medications and visits with a specialist.
Review your insurance plan to see which services are covered after you meet your deductible. You’ll save money on medical services if you use your health plan before your deductible resets.
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References
American Psychological Association. (2014). Does your insurance cover mental health services?
HealthCare.gov. (n.d.). Preventive health services.
