Key takeaways:
After you meet your deductible, your health insurance begins cost-sharing. This means your plan pays some or all costs for covered services.
Most health insurance plans cover preventive care, such as mammograms and immunizations, before you meet your deductible.
Check with your insurance plan to learn more about your annual deductible and determine which services are covered.
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. Your deductible depends on your specific plan. Often, you have a deductible for medical services and a separate deductible for prescription medication coverage. But once you’ve paid your deductibles, your health insurance will be responsible for some or all of the costs of covered care.
For example, if you have a $3,000 deductible, you’ll pay the first $3,000 of medical expenses before your insurance plan begins paying its share of covered costs. Typically, what you spend when you present your insurance card and receive covered services counts toward your deductible. After meeting your deductible, your costs for covered services will include your copay or coinsurance and any percentage of expenses outlined in your plan’s summary of benefits and coverage.
There’s one exception to meeting your deductible: preventive care. Most health insurance plans fully cover preventive health services — including screening mammograms, screening colonoscopies, and vaccines — even when you haven’t met your annual deductible and typically when provided by in-network healthcare professionals.
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What happens when you meet your deductible?
After you meet your deductible, your insurance will help you pay for covered healthcare services. But you may have to pay coinsurance or copays when you access care, 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. Your insurance company covers the remaining charges. For example: If you have met your deductible and have a $2,000 covered medical service that requires 20% coinsurance, you would be responsible for $400. Your insurance plan would pay 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 $20 copay for visits with a healthcare professional and a $10 copay for generic prescription medications (which may be covered by a separate prescription plan).
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 at the beginning of the year.
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 helps prevent melanoma or another skin cancer — or catch these conditions in their earliest stages.
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, hammertoe, 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 plan will help pay for medically necessary, elective surgery.
Other elective procedures that may be more affordable at the end of the year when you’ve met your deductible include:
Antireflux surgery
Joint repair, such as knee replacement surgery
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3. Imaging, lab work, and diagnostic testing
X-rays, blood work, and ultrasounds that don’t count as 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 until 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 has been met. But this may be helpful only up to a point, because you can 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 full physical therapy benefits — though you may still be responsible for copays or coinsurance.
5. Injections
If you receive injections such as testosterone, Prolia (denosumab) for osteoporosis, or medroxyprogesterone (Depo-Provera) for contraception — and you’re billed for every injection — meeting your deductible may help lower the costs.
Corticosteroid injections for pain and inflammation, for instance, may cost you less out of pocket once you reach your deductible.
6. Specialist visits
Has a primary healthcare professional referred you to a cardiologist, gastroenterologist, or 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 — but after you reach your deductible. Seeing a specialist 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 CGM (continuous glucose monitor)? Replacing medical equipment after you meet your annual deductible can save you money. And you can plan ahead for items that need periodic upgrades, such as 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 for less. You may be able to get a larger quantity, such as a 90-day supply of each medication. You’ll save money and be prepared for an emergency or 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 and most other commercial and government insurance plans must cover. Check with your health plan to see if your mental health needs are fully or partially covered before you meet your deductible and how cost-sharing works after you meet your deductible. Keep in mind that you typically need 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 health services at no cost to you. Even if you haven’t reached your annual deductible, you can typically access the following services without out-of-pocket costs when you use in-network health professionals and facilities:
Blood pressure screening
Depression screening
Diet counseling for adults at higher risk for chronic conditions
Immunizations (influenza, COVID-19, and more)
Type 2 diabetes screening for adults ages 40 to 70 who meet the guidelines for overweight or obesity
Urinary incontinence screening for women
Well-woman visits
Frequently asked questions
You meet your deductible by presenting your insurance coverage when accessing covered medical expenses, such as visits to a healthcare professional or lab tests, and paying the associated charges. Each payment counts toward your deductible. Once you reach the full deductible amount set by your plan, your insurance begins cost-sharing or covering a portion of the charges.
Your insurance deductible usually resets once a year, typically 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, such as the company’s fiscal year, so it’s a good idea to check your plan details. A deductible amount can change from year to year.
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. Self-pay healthcare likely won’t count toward your deductible.
No. After you meet your deductible, your out-of-pocket costs typically decrease, but they will likely not be eliminated. For covered services, you may still be responsible for coinsurance or copays. You'll also be expected to pay all costs associated with elective procedures or services that are not covered by your health insurance plan. You can check with a plan representative, visit your plan’s online portal, or check your summary of benefits and coverage to find out how much you'll be responsible for paying for a specific service or item after you meet the deductible.
It depends on the policy of the medical professional or facility involved. Some hospitals and surgery centers require estimated cost-sharing payments upfront. For that reason, always ask about how much and when you’ll be expected to pay. While your insurance plan may prohibit in-network providers from billing you upfront, they have no say over what an out-of-network healthcare professional or facility does. However, a federal law called the No Surprises Act protects most people with health insurance plans from being overcharged when accessing emergency care and out-of-network services.
You meet your deductible by presenting your insurance coverage when accessing covered medical expenses, such as visits to a healthcare professional or lab tests, and paying the associated charges. Each payment counts toward your deductible. Once you reach the full deductible amount set by your plan, your insurance begins cost-sharing or covering a portion of the charges.
Your insurance deductible usually resets once a year, typically 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, such as the company’s fiscal year, so it’s a good idea to check your plan details. A deductible amount can change from year to year.
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. Self-pay healthcare likely won’t count toward your deductible.
No. After you meet your deductible, your out-of-pocket costs typically decrease, but they will likely not be eliminated. For covered services, you may still be responsible for coinsurance or copays. You'll also be expected to pay all costs associated with elective procedures or services that are not covered by your health insurance plan. You can check with a plan representative, visit your plan’s online portal, or check your summary of benefits and coverage to find out how much you'll be responsible for paying for a specific service or item after you meet the deductible.
It depends on the policy of the medical professional or facility involved. Some hospitals and surgery centers require estimated cost-sharing payments upfront. For that reason, always ask about how much and when you’ll be expected to pay. While your insurance plan may prohibit in-network providers from billing you upfront, they have no say over what an out-of-network healthcare professional or facility does. However, a federal law called the No Surprises Act protects most people with health insurance plans from being overcharged when accessing emergency care and out-of-network services.
The bottom line
Most health insurance plans cover preventive care services such as mammograms, Pap smears, and immunizations before you meet your deductible. After you reach your deductible, your health insurance will help you pay for covered services. Review your plan’s summary of benefits and coverage to find out about preventive care that’s fully covered regardless of when you meet your deductible and how much you’re expected to pay for specific services after you meet your deductible. You may save the most on out-of-pocket costs if you use your insurance in the period after you meet your deductible and before your deductible resets in a new coverage year.
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References
American Psychological Association. (2014). Does your insurance cover mental health services?
Employee Benefits Security Administration. (n.d.). Avoid surprise healthcare expenses: How the No Surprises Act can protect you. U.S. Department of Labor.
HealthCare.gov. (n.d.). Preventive care benefit for adults. U.S. Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). Preventive care benefits for women. U.S. Centers for Medicare & Medicaid Services.
HealthCare.gov. (n.d.). Preventive health services. U.S. Centers for Medicare & Medicaid Services.
Randall, S., et al. (2024). Financial assistance and payment plans for underinsured patients shopping for ‘shoppable’ hospital services. Health Affairs Scholar.
