What happens if my insurance claim falls below the deductible level?

Though the ins and outs of health insurance are often confusing, the concept of the insurance deductible is relatively straightforward. Your health insurance deductible is the amount that you must contribute out of pocket towards your health care before your insurance policy begins paying for services. If your insurance claim falls below the level of your deductible, you are responsible for paying 100% of your claims until your deductible is fulfilled. In some cases, your plan may cover select services before the deductible is met.

Deductible Example

Assume the annual deductible on your policy is $1,500. After going to the doctor for a routine physical, you receive a bill for $800. The doctor's office automatically bills your insurance, but because $800 is below the $1,500 deductible, the insurance company passes this cost on to you for payment. Once you have paid the $800, your deductible is reduced to $700 for the rest of the year.

Once you have paid $1,500 for health care services, your insurance company pays some or all of your health expenses for the rest of the year. However, your deductible resets with each new year and may increase or decrease depending on your plan, provider and employer-sponsored options.

What Happens After My Deductible Is Satisfied?

After you have satisfied your deductible, the amount that your insurance company pays for health services is determined by either a copay or coinsurance provision, depending on your plan. A copay is a flat fee that you pay directly to the service provider each time you have an appointment. Coinsurance refers to a stated percentage of service cost that your insurance company promises to pay on your behalf once your deductible is satisfied.

Deductible Options

It stands to reason that a lower deductible means that your insurance company pays for more of your annual health expenses. Most insurance companies offer lower deductible options in exchange for a higher annual premium. Depending on your health needs, it may be worth the extra money upfront to have more extensive coverage throughout the year.