Family Health Insurance Deductibles

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.

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.

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.

Choosing a High-deductible or Low-deductible Family Plan

Choosing a plan depends on the health of your family.

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