A health insurance deductible is the amount you pay for covered care before your insurance begins to pay, and it resets every plan year.
Definition
A deductible is the amount you pay for covered health care each year before your insurance starts paying its share (except for preventive care, which is often free).
Example
With a $2,000 deductible, you pay the first $2,000 of covered care. After that, you pay coinsurance (like 20 percent) until you reach your out-of-pocket maximum.
Related terms
- Copay: a fixed fee per visit.
- Coinsurance: your percentage share.
- Out-of-pocket maximum: the most you pay in a year ($9,200 for individuals in 2025 on ACA plans).
Resets
Usually each January or plan year.
HSA plans
High deductible plans can pair with a health savings account.
Premium
The monthly cost, not part of the deductible.
What a deductible is
A deductible is the amount you pay for covered health care services each year before your insurance starts to pay. It does not include your monthly premium. Many plans cover certain preventive services, such as annual checkups and vaccinations, before the deductible is met, as required by the Affordable Care Act.
Example
Say your plan has a $2,000 deductible, a 20% coinsurance and a $6,000 out-of-pocket maximum. You have a surgery that costs $10,000. You pay the first $2,000, which is the deductible. For the remaining $8,000 you pay 20%, which is $1,600. Your total is $3,600, and insurance pays $6,400. If you have more care later that year, you pay 20% until you reach the out-of-pocket maximum of $6,000, and then the plan pays 100% of covered services.
Related terms
- Premium: the monthly amount you pay to keep coverage.
- Copay: a fixed fee for a service, such as $30 for a doctor visit.
- Coinsurance: your percentage share after the deductible.
- Out-of-pocket maximum: the most you pay in a year for covered in-network care. For 2024 the legal limit is $9,450 for an individual and $18,900 for a family.
- In-network: providers that have contracts with your plan and charge lower rates.
Embedded and family deductibles
Family plans may have an individual deductible within a family deductible (embedded), or only an overall family deductible, which must be met before the plan pays. Check which type your plan has.
Resets
Most deductibles reset every year on January 1 for calendar year plans, or on the plan renewal date. Some plans carry over a portion of costs to the next year in the last quarter. Unused deductible amounts do not roll over.
HSA plans
High deductible health plans (HDHPs) have deductibles of at least $1,600 for an individual and $3,200 for a family in 2024. They can be paired with a health savings account (HSA), which lets you set aside pre-tax money: up to $4,150 for an individual and $8,300 for a family in 2024, plus $1,000 if age 55 or older. HSA money rolls over every year.
Premium trade off
Plans with lower premiums often have higher deductibles, and vice versa. Compare the total annual cost, including premiums and expected care, when choosing a plan. Average deductibles for employer plans were around $1,735 for single coverage in 2023, according to KFF.
Typical amounts and real numbers
In 2023, the average annual deductible for single coverage in employer plans was about 1,735 USD, according to the KFF Employer Health Benefits Survey, and about 4 in 10 covered workers faced a deductible of 2,000 USD or more in smaller firms. For 2025, the maximum out of pocket limit for ACA marketplace plans is 9,200 USD for an individual. Preventive care such as annual checkups, many vaccines and certain screenings must be covered without cost sharing, even before meeting a deductible, under the Affordable Care Act. Primary care visits and some prescriptions may carry a flat copay before the deductible in some plans. Premiums and out-of-network charges generally do not count toward the in-network deductible. Always check the summary of benefits and coverage for your plan.
Based on data from KFF and HealthCare.gov
