What does it mean that health insurance pays a certain percentage after a deductible?

March 27, 2011
By theinsurancepedia

In most insurance plans, you have a deductible you are required to pay, like $500, then after that, you pay a certain percentage of the remaining medical expenses, such as 20%. If my medical deductible is $500, then I must pay the first $500 dollars of medical expenses before my insurance will start paying 80% of expenses past that, while I pay 20%. Look at this example:
My son breaks his arm, and the entire cost from doctor visits to cast is $800. I pay my $500 deductible, and then $300 is left. Of that remaining $300, I will pay 20%, ($60) while the insurance company pays 80%($240.)
Keep in mind that your deductible starts over every calendar year. Once you have paid it, you only have to pay 20% for the rest of the year. Some exclusions could apply to certain conditions/ charges like prescriptions, pregnancy, etc. Also remember that the higher your deductible is, the lower your health insurance is. Decide how much you use your insurance and choose accordingly.

Related posts:

  1. What is the difference between an annual deductible and an annual out-of-pocket maximum on health insurance?
  2. When does a health care deductible start over?
  3. How does the deductible work on a health insurance plan?
  4. Who pays for my car’s damage when the insurance only pays the deductible?
  5. What is the difference between a coinsurance and a deductible?

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