Understanding Medical Deductibles: What Happens if You Don't Meet It?

Many health plans don't pay benefits until your medical bills reach a specified amount, called a deductible. This could be $1,000, $2,000 or even more, depending on the type of plan you choose. If you don't meet the minimum, your insurance won't pay toward expenses subject to the deductible. Nonetheless, you may get other benefits from the insurance even when you don't meet the minimum requirement.

When the Deductible Doesn't Apply

The deductible doesn't always apply to all types of medical services. Depending on the particular plan, your health insurance company may pay certain costs even before you meet the deductible. For example, many plans cover preventive services, including regular check-ups and required vaccines, with no deductible. Some plans also cover medications before you meet the deductible.

How Insurance Reduces Prices

Even if you don't meet the deductible, you can save money on services that are subject to it. Insurers typically negotiate lower prices, so you'll save half off the regular price on average compared to someone without insurance, according to the HealthCare.gov website.

For example, you may have a $1,500 deductible and receive a service normally costing $1,000. Your insurance company won't pay if you haven't met the deductible. However, if it negotiates a cost of $500, you'll save $500, even if that amount comes out of pocket.