Family Health Insurance Deductibles

We’ll help you understand how deductibles work in family health insurance plans.

What is a deductible?

A deductible is the amount of money per year that you need to pay for your health care costs (such as doctor’s visits, medication, etc.) Once you meet your deductible, your plan will begin to help pay for your health care costs. This is called coinsurance.

An individual deductible is the amount one person needs to meet for coinsurance to kick in.

A family deductible is the maximum amount that a family needs to meet for coinsurance to kick in for everyone in the family.

Most plans cover in-network preventive care at 100% without requiring a deductible to be met. Some plans may even waive the deductible for other covered health care costs.

However, some plans do require that you meet your deductible.

We’ll explain more about how deductibles work in individual plans vs. family plans.

Current Cigna Customers

If you have registered for myCigna® you can log in to view your deductibles on your coverage page.

How Deductibles Work in Individual Plans vs. Family Plans

Individual Plan: An individual plan covers one person. So if you have an individual plan, only you will need to meet your deductible before your coinsurance kicks in and your plan starts to help pay for your health care costs.

Family Plan: A family plan has at least two family members covered by your plan.

Family Deductible Plans

There are two types of family deductible plans.

Family Deductible Plans

This type of plan has an overall family deductible. Health care costs for all your family members throughout the plan year are added together and applied toward the family deductible.

Once your family deductible is met, coinsurance will kick in for each family member, and your plan will help pay their additional health care costs for the plan year.

Video: Family Deductible Plans

Watch this short video to learn how family deductible plans work. (Length: 01:12)

Family Plans with Individual Deductibles (Embedded Deductible)

This type of plan has an overall family deductible and each family member also has their own individual deductible.

For example, in a family of four, if any family member reaches their individual deductible, then the deductible is satisfied for that family member. Additional claims for that family member are paid by coinsurance, no longer contribute to the family deductible, and are applied to the out-of-pocket maximum.*

If any combination of family members’ deductible amounts totals the family deductible maximum, then the deductible is satisfied for the entire family. Additional claims for everyone in the family are paid by coinsurance and are applied to the individual and family out-of-pocket maximums.

*The out-of-pocket maximum is the most you could pay for covered medical expenses in a year. This amount includes money you spend on deductibles, copays, and coinsurance. Once you reach your annual out-of-pocket maximum, your health plan will pay your covered health care costs for the rest of the plan year.

Video: Family Deductible Plans with Individual Deductibles

Watch this short video to learn how family plans with individual deductibles work. (Length: 01:36)

Choosing a High-deductible or Low-deductible Family Plan

Choosing a plan depends on the health of your family.

High-deductible Plan Features Low-deductible Plan Features

A high-deductible plan may be a better fit if your family is healthy and won’t need anything more than preventive care.

You’ll pay a lower premium (the amount you pay for your plan, usually monthly) but it may take longer for you to meet your deductible.

Plan features:

  • Higher deductible
  • Higher out-of-pocket maximum limits
  • Lower premiums
  • May offer a health savings account (HSA) to help manage costs

A low-deductible plan may be a better fit if you’re older, have a chronic condition, are pregnant, or require expensive prescriptions.

You’ll pay a higher premium (the amount you pay for your plan, usually monthly) but you can meet your deductible sooner.

Plan features:

  • Lower deductible
  • Lower out-of-pocket maximum limits
  • Higher premiums
  • Do not offer a HSA

How do I switch from an individual plan to a family plan?

You can change your plan or add or remove a dependent during open enrollment and special enrollment.

Family deductibles can vary depending on your family health insurance plan, and making a selection can depend on the health needs of your family. With this in mind, be sure to understand your deductible and plan features when it’s time to enroll. Learn more about enrolling in an individual or family plan

View Your Plan Deductibles

If you are a current Cigna customer and have registered for myCigna, you can view your deductibles on your coverage page.

This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. Any third party content is the responsibility of such third party. Cigna does not endorse or guarantee the accuracy of any third party content and is not responsible for such content. Your access to and use of this content is at your sole risk.