Understanding 100% Coverage After Deductible: What It Means

Low out-of-pocket expenses are one key to a valuable health insurance policy. Along with a low annual deductible that you pay toward covered health events, a low co-insurance percentage greatly minimizes your costs. One hundred percent after deductible means your insurer pays 100 percent of the post-deductible expenses on a bill, and you pay nothing out of pocket besides that deductible.

Deductible Basics

Deductibles are common on many types of insurances, including home, auto, health and dental. On a health insurance policy, for instance, you might have a $500 annual deductible for hospital admissions. With a home policy, deductibles often range from $250 to $2,000. Full-service auto policies include deductibles on both collision and comprehensive coverage at varying amounts. With dental insurance, deductibles are normally around $25 to $75.

Co-Insurance Basics

The 100 percent amount in the phrase "100 percent after deductible" references a co-insurance structure. Co-insurance is shared obligations between the insurer and the covered member on service fees. With a 100 percent after-deductible benefit, you have no co-insurance. Another common co-insurance format is 80/20. This co-insurance level means that your insurance company pays 80 percent after deductible, and you pay 20 percent. If the post-deductible balance is $2,000, for instance, you pay $400 and the insurer pays $1,600.

Claims Process

When you go to the hospital for a planned surgery, the facility normally sends you a statement noting what you owe on the appointment date. If your health provider pays 100 percent after deductible, and your deductible is $500, your statement would indicate that you owe $500. If the total bill is $5,500, the insurance provider picks up the remaining balance of $5,000. In contrast, on an 80/20 co-insurance plan, you would owe $500 plus 20 percent of $5,000, which is an additional $1,000.

Other Considerations

Some people have health policies with deductibles that vary between in-network and out-of-network providers. Your insurance company might pay 100 percent after deductible on in-network benefits, for instance, but pay 80 percent of after deductible expenses for out-of-network care. Policies often have out-of-pocket maximums as well, which means that even if you don't have 100 percent after deductible coverage, you may have a cap on how much you have to spend each year.