Understanding Your Deductible

A health insurance deductible is the amount you pay out of pocket for covered medical services before your plan begins to share in the costs. For example, if your plan has a $1,000 deductible, you generally pay the first $1,000 of covered expenses yourself; after that, your insurance starts paying its share. Deductibles can range from a few hundred dollars to several thousand, depending on the plan, and they reset each plan year. Preventive services like annual checkups are often covered before you meet your deductible.

After you meet your deductible, you typically pay coinsurance — a percentage of the cost of services — until you reach your out‑of‑pocket maximum. The out‑of‑pocket maximum caps how much you spend in a year on covered care and includes your deductible, copayments and coinsurance. For 2025 plans, federal law sets a maximum of $9,200 for individuals and $18,400 for family plans, though many plans have lower limits. Once you hit this cap, the insurance company pays 100% of covered services for the remainder of the year.

Deductibles can be structured in different ways. Some plans have separate deductibles for each family member, while others have an aggregate family deductible that must be met before coverage kicks in for anyone. Plans may also have separate deductibles for in‑network versus out‑of‑network services, or separate deductibles for certain benefits, such as prescriptions. In general, plans with lower deductibles have higher monthly premiums, while plans with higher deductibles have lower premiums but more cost sharing when you need care. High‑deductible health plans can be paired with a Health Savings Account to save pre‑tax dollars for medical expenses. When choosing a deductible, think about your anticipated healthcare needs and budget — and feel free to speak with Fortura Insurance Agency for personalized guidance.