Deductible
In health insurance, your plan deductible is the amount you have to pay in medical expenses before your insurance plan begins to pay for services that are "subject to the deductible."
In common plans, some examples of services that are subject to the deductible are emergency room visits, hospital visits, some lab work, and surgeries. In an HSA plan, doctor office visits and prescriptions are also subject to the deductible before the insurance will pay for services.
COPAY plan example
Plan Deductible: $2,500
Plan Coinsurance: 80%/20%
Plan Out-of-Pocket Maximum: $7,000
Plan Copays: $35
Plan Rx Copays: $15/$25/$45
Services that have a Copay
Using the plan example above, you pay the $35 copay.
Annual Preventive
Regular Doctor
Specialist Doctor
Hearing Exam
Outpatient Mental Health
Chiropractic Care
Acupuncture
Outpatient Physical Therapy
Outpatient Occupational Therapy Outpatient Rehabilitation
Prescriptions
Services Subject to the Deductible
Using the plan example above, you pay the full cost of these services until you have paid your $2,500 deductible, then you pay 20% of the total cost until you have paid $7,000 for the year. Then the plan will pay 100% for covered services.
AmbulanceÂ
Emergency Room
Inpatient Mental Health
Inpatient Rehabilitation
Inpatient Physical Therapy
Orthotics / Durable Medical Equipment
Hospice
Organ Transplants
SurgeryÂ
Hospital Visits
Prescriptions
Using the plan example above, you pay the corresponding copay: $15 for Preferred Generic prescriptions, $25 for Preferred Brand name prescriptions, $45 for Non-Preferred Generic and Brand name prescriptions
Preferred Generic
Preferred Brand Name
Non-Preferred Generic
Non-Preferred Brand Name
HSA plan example
Plan Deductible: $2,500
Plan Coinsurance: 80%/20%
Plan Out-of-Pocket Maximum: $7,000
​
Services that have a Copay
In an HSA plan, you do not have copays for services.
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Services Subject to the Deductible
Using the plan example above, you pay the full cost of these services until you have paid your $2,500 deductible, then you pay 20% of the total cost until you have paid $7,000 for the year. Then the plan will pay 100% for covered services.
Annual Preventive
Regular Doctor
Specialist Doctor
Hearing Exam
Mental Health
Chiropractic Care
Acupuncture
Physical Therapy
Occupational Therapy
Rehabilitation
Prescriptions
AmbulanceÂ
Emergency Room
Orthotics / Durable Medical Equipment
Hospice
Organ Transplants
SurgeryÂ
Prescriptions
Hospital Visits