Deductible
A deductible is the amount you pay for covered health care services each plan year before your before your health plan starts sharing the cost. For example, if your deductible is $1,000, you pay the first $1,000 of covered services before the insurance plan starts to pay its share. Once you reach your deductible, your insurance usually begins sharing the cost of covered services based on your benefits.
Last updated: September, 2026
Key Takeaways
- A deductible is the amount you pay for covered health care services before your insurance starts sharing the cost.
- Deductibles can be different from one health plan to another.
- Insurance plans with lower monthly premiums often have higher deductibles.
- Some services, like preventive care, may be covered before you meet your deductible.
- Knowing your deductible can help you plan for health care costs during the year.
What is a Deductible?
A deductible is the amount you pay for covered health care each plan year before your health plan starts sharing certain costs. You pay this amount yourself over the insurance plan year. After you meet the deductible, you may still have other costs, like copays or coinsurance, depending on your coverage.
Not every health service works the same way. Some services may be covered before you meet your deductible.
For example, many preventive services are covered when you use an in-network provider. Deductibles can be different for medical care, prescription drugs, or out-of-network care. Checking your coverage details can help you understand when your deductible applies.
How This Shows Up in Real Life
Let’s say your deductible is $1,000. Early in the year, you have a lab test that costs $250 and an imaging test with an allowed amount of $350. Because you have not met your deductible yet, you pay those costs yourself.
Later, you have another covered service with an allowed amount of $500. At that point, you have already paid $600 toward your deductible, so you pay the remaining $400 to meet it.
After that, your insurance plan starts sharing the cost of covered services based on your benefits.
Here is a simple way to think about how a deductible works during the year:
- You pay first for covered services until you reach your deductible
- Your insurance starts sharing costs after the deductible is met, based on your benefits
- Your deductible resets at the start of each new plan year
Deductible Example | Amount |
|---|---|
Yearly deductible | $1,000 |
Lab test | $250 |
Imaging test | $350 |
Total paid so far | $600 |
Next covered service | $500 |
You pay to meet deductible | $400 |
Remaining amount after deductible is met that is subject to your insurance plan's cost sharing rules | $100 |
How a Deductible Affects What You Pay
A deductible can have a big effect on what you pay early in the year. If you need care before meeting it, you may pay more out of pocket at first. After you meet it, your insurance usually starts sharing more of the cost.
At that point, you may still pay copays or coinsurance depending on your coverage.
Insurance plans with higher deductibles often have lower monthly premiums. Coverage with lower deductibles often have higher monthly premiums. That is why it helps to compare both your monthly premium and your deductible when you pick a health insurance plan.
Where to Find This in Your Plan Details
To check your deductible, you can look at:
- Your Summary of Benefits and Coverage (SBC)
- Your Schedule of Benefits
- Your member handbook or policy documents
- Your health plan’s website, your Ambetter Health online member account, or the mobile app.
These resources can help you check whether your deductible applies to medical care, prescriptions, or out-of-network services.
How This Changes Across Marketplace Plans
Deductibles can vary across Marketplace health insurance plans. The amount you pay often depends on the health plan category you choose, the services you receive, and whether you use in-network or out-of-network providers. Insurance plans with lower monthly premiums often have higher deductibles, while coverage with higher premiums may have lower deductibles.
Comparing both the monthly premium and the deductible can help you choose an insurance plan that fits your budget and health care needs.
Key Differences to Know
- Lower-premium insurance plans often come with higher deductibles.
- Higher-premium insurance plans may have lower deductibles.
- Some services, like preventive care, may be covered before you meet your deductible.
- Comparing both monthly premium and deductible can help you choose the right plan.
FAQs About Deductible
No. A deductible is the amount you pay for covered health care services before your health plan starts sharing certain costs. A copay is a fixed amount you pay for a specific service, such as a doctor visit or prescription. In some insurance plans, copays may count toward your out-of-pocket maximum, but they do not always count toward your deductible. Both are types of cost sharing, but they work in different ways under your coverage.
Not always. Some services may be covered before you meet your deductible, depending on your insurance plan’s rules. Preventive care is a common example when you use an in-network provider. Checking your coverage documents can help you see which services are covered before the deductible applies.
Usually, yes. Most health plans reset the deductible at the start of each new insurance plan year. This means the amount you paid toward the deductible during the previous year does not carry over. Your insurance documents can confirm the exact timing for your coverage.
After you meet your deductible, your health plan usually begins sharing the cost of covered services. Depending on your benefits, you may still pay copays or coinsurance when you receive care. Your coverage documents can explain how cost sharing works after the deductible is met.
Yes. Some health plans have separate deductibles for different types of coverage. For example, an insurance plan may have one deductible for medical services and another for prescription drugs. Some insurance plans also have different deductibles for in-network and out-of-network care.
Related Terms
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What Is Coinsurance in Health Insurance?
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What Is Cost Sharing in Health Insurance?
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What Is an Allowed Amount in Health Insurance?
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Learn MoreHave Questions About How This Works with Your Ambetter Health Plan?
Already covered? Your benefits vary by plan and location. Limitations and exclusions may apply. Contact Ambetter Health or call Member Services at the number on the back of your Member ID Card for answers specific to your coverage.
Not yet a member? Our licensed agents are ready to help you find the perfect plan. Call 855-680-3270 (TTY: 711), Monday-Friday 8 a.m. to 9 p.m. ET, to discuss your health insurance options.
Sources:
Healthcare.gov - Your total costs for health care: Premium deductible & out-of-pocket costs, 3 things to know before you pick a health insurance plan
CMS.gov - No surprises: Health insurance terms you should know (PDF)