Is it good or bad to have a deductible for health insurance?
Asked by: Dr. Declan Emard | Last update: January 21, 2026Score: 4.3/5 (15 votes)
Is it better to have a deductible or not for health insurance?
Higher deductibles are usually cheaper. If you don't visit the doctor very often, you will probably spend less per year in a normal year. However, you are covered if something unexpected happens like a surgery. Plans with a lower deductible are generally more expensive, but you reach your deductible faster.
Is it better to have no deductible for health insurance?
Health insurance with zero deductible or a low deductible is best if you expect to need major medical care in the upcoming year. Even though you'll pay more for the plan, it will help you save overall because the full benefits begin right away.
Is it better to have a high or low deductible?
What makes more financial sense, low or high insurance deductibles? There is NO generally speaking rule on this. It is all MATH. If the higher deductible saves enough money to warrant the higher deductible, take the higher deductible. If the savings on a higher deductible is negligible, keep the lower deductible.
What is the downside of having a deductible?
Cons. Higher deductible: If your deductible is higher, it means you are required to pay for your medical care out of pocket up to that amount before your health plan begins to help pay for covered costs. The exception is for preventive care, which is covered at 100% under most health plans when you stay in-network.
The Concept of Deductible in Health Insurance
Who should not use a high deductible health plan?
A chronic illness, such as heart disease or diabetes, can be much more expensive to manage under an HDHP than a traditional health care plan. With these conditions, regular medications and health screenings may be required. These costs may quickly add up until deductibles are finally met.
What is a disadvantage of having a high deductible?
The main drawback of an HDHP is high out-of-pocket expenses for nonpreventive care. If you're healthy but go to urgent care a few times, you can pay a lot out of pocket but not exceed your yearly deductible. Or you could require unexpected expensive treatment early in the year.
Do copays count towards deductible?
No. Copays and coinsurance don't count toward your deductible. Only the amount you pay for health care services (like the medical bill you receive) count toward your plan's deductible.
What is a good premium for health insurance?
PREMIUMS FOR SINGLE AND FAMILY COVERAGE
The average premium for single coverage in 2024 is $8,951 per year. The average premium for family coverage is $25,572 per year [Figure 1.1].
What happens if you don't meet your healthcare deductible?
(For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered health care services subject to the deductible.)
Is hmo or ppo better?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
Is it better to have a $500 deductible or $1000?
Remember that filing small claims may affect how much you have to pay for insurance later. Switching from a $500 deductible to a $1,000 deductible can save as much as 20 percent on the cost of your insurance premium payments.
What if I can't afford my health insurance deductible?
Your healthcare provider can't waive or discount your deductible because that would violate the rules of your health plan. But they may be willing to allow you to pay the deductible you owe over time. Be honest and explain your situation upfront to your healthcare provider or hospital billing department.
Will my insurance go up if I use my deductible?
A high deductible will lower your overall insurance rate, however it will increase your out-of-pocket costs if you file a claim.
Why would you want a deductible?
Insurance policies use deductibles to ensure a measure of financial stability on the part of the insurer by reducing the severity of claims. A policy that is properly structured provides protection against catastrophic loss. A deductible provides a cushion between any given minimal loss and a truly catastrophic loss.
Is it better to have a high or low deductible for health insurance?
A lower deductible plan is a great choice if you have unique medical concerns or chronic conditions that need frequent treatment. While this plan has a higher monthly premium, if you go to the doctor often or you're at risk of a possible medical emergency, you have a more affordable deductible.
Do doctor visits count towards the deductible?
For example, a health plan may apply a deductible for covered inpatient and outpatient hospital services. Doctor visits, however, may be exempt from the plan's deductible. Instead of a deductible, your cost-share amount might be a flat dollar amount, such as a $30 copayment for each office visit.
Why do doctors bill more than insurance will pay?
It is entirely due to the rates negotiated and contracted by your specific insurance company. The provider MUST bill for the highest contracted dollar ($) amount to receive full reimbursement.
Why is it not a great idea to have a high deductible?
Large medical expenses: Since HDHPs generally only cover preventive care, an accident or emergency could result in very high out-of-pocket costs. Future health risks: Because of the costs, you may refrain from visiting a physician, getting treatments, or purchasing prescriptions when they're not covered by your HDHP.
What are the disadvantages of a deductible?
- Delayed Care. If you have a high health insurance deductible, you may hesitate to seek medical care until you've met your deductible. ...
- Limited Provider Network. ...
- Higher Out-of-Pocket Costs. ...
- Complexity of Healthcare Costs.
What should you always do when purchasing health insurance?
Four things you should think about when choosing coverage - costs, provider network, benefits, and quality.
How much should I pay for health insurance?
Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.
Why choose a high deductible health plan?
Typically lower premiums: These types of plans usually cost less per month than more traditional health plans with a lower deductible. Ability to use an HSA: Having a qualified HDHP means you're eligible to put thousands of pretax dollars into an HSA, which you can use for medical expenses this year or in the future.
What should my deductible be for full coverage?
$500 is the most common car insurance deductible. Not every type of car insurance coverage uses a deductible. A higher car deductible can lower your insurance premium. You pick your deductible when buying insurance.