What is the amount you are personally responsible for before the insurance company will pay anything?

Asked by: Lou Bahringer  |  Last update: December 15, 2025
Score: 4.9/5 (71 votes)

A deductible is the amount you pay for most eligible medical services or medications before your health plan begins to share in the cost of covered services.

What is the amount you pay before the insurance company pays?

Deductible – An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services.

What is the amount you pay for a loss before the insurance company pays anything?

Deductible - The amount the insured must pay in a loss before any payment is due from the company.

Does insurance pay anything before the deductible?

Many plans pay for certain services, like a checkup or disease management programs, before you've met your deductible. Check your plan details. All Marketplace health plans pay the full cost of certain preventive benefits even before you meet your deductible.

What is the amount of money you are responsible for paying on a personal loss before the insurance company will pay?

and how it works can help consumers make informed decisions when purchasing insurance and filing claims. Simply put, a deductible is the amount of money that the insured person must pay before their insurance policy starts paying for covered expenses.

How Health Insurance Works | Personal Finance Series

42 related questions found

Is the amount you are personally responsible for before the insurance company will pay anything?

Deductible: This is the amount you must pay each year before your insurance begins to pay. Some policies have separate deductibles for prescription drugs and hospital care.

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.

Do you pay 100 before deductible?

If you haven't met your deductible: You pay $100, the full allowable amount for the visit.

What if I need surgery but can't afford my deductible?

In cases like this, we recommend contacting your insurance, surgeon, or hospital and asking if they can help you with a payment plan. Remember that your surgery provider wants to get paid so they may be very willing to work with you on a payment plan.

Do I have to pay a deductible for a doctor visit?

Summary. Depending on a patient's health plan, credit history, medical needs, and choice of hospital, the patient may be asked to pay some or all of their deductible upfront, before receiving medical care.

Who is liable when an insured suffers a loss?

In general, the insurer is liable for the losses covered by the insurance policy, up to the limits of the policy. The insurer is also responsible for investigating the claim, determining the cause of the loss, and assessing the extent of the damages.

What are subrogation rights?

“Subrogation” refers to the act of one person or party standing in the place of another person or party. It is a legal right held by most insurance carriers to pursue a third party that caused an insurance loss in order to recover the amount the insurance carrier paid the insured to cover the loss.

Is a $2500 deductible good home insurance?

For customers who have enough money in an emergency fund to handle it, experts often advise that the savings that come with a higher deductible are worth it. By switching from a $500 deductible policy to a $2,500 deductible, customers save more than $500 per year on average on premiums, according to Insurance.com.

Can I keep extra money from an insurance claim?

You may be able to keep excess money as long as you're not violating your provider's rules or committing insurance fraud.

What happens if I don't use my insurance money to fix my roof?

If you don't complete repairs or a replacement, however, your insurance provider will likely just decide to no longer cover your roof. This means if another storm deals further damage, you won't be covered and will have to pay for the replacement out of pocket.

What happens when you reject an insurance settlement offer?

When you reject a settlement offer, it triggers negotiations between you (or your lawyer) and the insurance company. This allows you to submit a counteroffer that better reflects the value of your damages, such as medical bills, lost wages, and pain and suffering.

What happens if you get surgery and can't pay?

You can take steps to make sure that the medical bill is correctly calculated and that you get any available financial or necessary legal help. If you do nothing and don't pay, you could be facing late fees and interest, debt collection, lawsuits, garnishments, and lower credit scores.

Do you have to pay full deductible before surgery?

Doctors want to be sure that they will be compensated for the care they provide. Fourth lesson: It is not illegal to be asked to pay what you may owe in advance for a major medical event. But if you are asked to pay upfront, legally you don't have to.

What happens if I can't afford to pay my deductible?

If you can't pay your auto or home insurance deductible, you won't be able to file a claim and get your repairs covered.

Will insurance pay anything before deductible?

On some plans, certain services are covered with a copay before you've met the deductible, while other plans have copays only after you've met your deductible. And the pre-deductible versus post-deductible copay rules often vary based on the type of service you're receiving.

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.

How can I hit my deductible fast?

How to Meet Your Deductible
  1. Order a 90-day supply of your prescription medicine. Spend a bit of extra money now to meet your deductible and ensure you have enough medication to start the new year off right.
  2. See an out-of-network doctor. ...
  3. Pursue alternative treatment. ...
  4. Get your eyes examined.

What happens if my repairs cost less than the deductible?

What if my car repair costs less than my deductible? There may be times when your car insurance deductible is more than the cost of the damage to your vehicle. Unfortunately, in these cases, you'll need to pay for all repairs out-of-pocket. This is because insurance only pays for damages that are above your deductible.

Is a credit score check required to get auto insurance?

Most insurers use credit checks to create a credit-based insurance score to help set your rate. Some insurers provide auto insurance with no credit check, which might seem appealing if you have a poor credit history.

How to get a new roof without paying deductible?

No matter what a roofer tells you you must pay your deductible. There is no way around it and insurance will consider it insurance fraud if they do. Many homeowners try to find a way around this but there is no way around it. You can also verify this directly with your insurance provider or an attorney.