What happens if I don’t meet my health insurance deductible?
If you don't meet your deductible, your insurer will not provide coverage for most medical expenses subject to that deductible.
You'll be responsible for paying the full cost out-of-pocket.
The average health insurance deductible for individual coverage was $1,945 in 2020, making it challenging for many to meet their full deductible each year.
Deductibles have been steadily rising, with some plans now having deductibles as high as the maximum allowed out-of-pocket cost, which was $9,450 for a single individual in 2024.
Even if your insurer negotiates a lower rate with a provider, you'll still have to pay the full negotiated amount out-of-pocket until your deductible is met.
Healthcare providers generally cannot waive or reduce deductibles due to insurance regulations, though they may offer payment plans to help patients manage the costs.
Failing to meet your deductible could mean delayed care or being unable to receive necessary services altogether if you can't afford the out-of-pocket costs.
Health Savings Accounts (HSAs) can help manage deductible costs by allowing you to save and pay for qualified medical expenses with pre-tax dollars.
In 2025, the cap on out-of-pocket costs will decline for the first time, dropping from $9,450 to $9,200 for a single individual.
Once you've met your deductible, your insurance plan will typically cover a large percentage of your medical costs, often 80% or more, through coinsurance.
If you have a high-deductible health plan, you may be eligible for a tax deduction on your medical expenses that exceed 7.5% of your adjusted gross income.
Some preventive care services, like annual checkups and recommended screenings, are often covered 100% by insurance even before you've met your deductible.
Negotiating with healthcare providers for discounted rates or payment plans can help manage the out-of-pocket costs if you haven't met your deductible.
Researching and comparing healthcare costs before receiving treatment can help you budget and prepare for meeting your deductible.
Certain types of care, like emergency services, may be covered by your insurance even before you've met your deductible, though you'll still be responsible for any applicable copays or coinsurance.
If you have multiple family members on your health insurance plan, your deductible and out-of-pocket maximum may be higher, but the plan will start paying benefits once the family deductible is met.
In some cases, your insurer may apply a portion of your deductible towards your next plan year if you haven't fully met it by the end of the current year.
Preventive care services like immunizations, cancer screenings, and well-child visits are often exempt from deductibles and covered at 100% by most health plans.
The Affordable Care Act requires all Marketplace plans to cover a set of essential health benefits, which are subject to deductibles and other cost-sharing requirements.
If you have a chronic condition or ongoing medical needs, it may be worth considering a plan with a lower deductible, even if the monthly premiums are higher.
Reviewing your plan's coverage details and negotiating with providers can help you better understand and manage your deductible and out-of-pocket costs.