Quick answer
A deductible is the amount you pay for covered health care each year before your insurance starts paying its share. With a $2,000 deductible, you pay the first $2,000 of covered costs yourself, then usually a copay or coinsurance after that. Many services, including preventive checkups and screenings, are covered before you meet it.
Key takeaways
- The deductible resets every plan year, usually on January 1.
- Preventive care is free in network even before you meet the deductible, and many plans cover some visits and drugs with just a copay.
- Lower deductibles come with higher premiums, and higher deductibles with lower premiums.
- Family plans usually have a deductible for each person plus a family deductible for everyone combined.
- What you pay toward the deductible counts toward your out-of-pocket maximum, the most you’ll pay for covered in-network care in a year.
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How a deductible works
Say your plan has a $2,000 deductible and 20% coinsurance, and you need a $5,000 in-network surgery:
- You pay the first $2,000, which meets your deductible.
- You pay 20% of the remaining $3,000, or $600, as coinsurance.
- Your plan pays the other $2,400.
You pay $2,600 in total. For the rest of the year, covered care costs you only copays or coinsurance until you reach your out-of-pocket maximum, and after that the plan pays 100% of covered in-network care. How you meet your deductible explains what counts.
These amounts are based on your plan’s negotiated rates, not the provider’s list price. That’s one reason to check that a doctor is in network before you go.
What’s covered before the deductible
You don’t pay full price for everything until the deductible is met:
- Preventive care such as yearly checkups, recommended screenings and vaccines is free in network under the ACA.
- Copay services. Many plans charge a flat copay for doctor visits, urgent care or generic drugs whether or not you’ve met the deductible.
- Catastrophic plans cover three primary care visits a year before the deductible.
Your plan’s summary of benefits shows which services skip the deductible.
Types of deductibles
- Individual and family deductibles. On most family plans, each person has a deductible, and once the family together meets the family deductible, cost-sharing kicks in for everyone. Some high-deductible plans only use the family amount.
- In-network and out-of-network deductibles. Plans that cover out-of-network care usually have a separate, higher deductible for it. See what to do about out-of-network costs.
- Drug deductibles. Some plans have a separate deductible for prescriptions.
- Two plans at once. Each plan has its own deductible. See how deductibles work with two health insurance plans.
How big deductibles are now
Deductibles keep climbing. The average deductible for single coverage through an employer was $1,886 in 2025, according to KFF. Marketplace deductibles run higher: the average was $3,786 per person in 2026, partly because more people chose bronze plans after the larger subsidies expired.
On the marketplace, bronze, silver, gold and platinum plans go from the highest deductible and lowest premium to the lowest deductible and highest premium. If your income is under 250% of the federal poverty level, silver plans come with much lower deductibles through cost-sharing reductions.
Choosing a deductible
A low deductible makes sense if you expect regular care, like ongoing prescriptions, a planned surgery or a pregnancy. A high deductible can save money if you’re healthy and have savings to cover a large bill, especially paired with an HSA. Ask yourself how much care you’re likely to need this year, and whether you could pay the whole deductible if something happened tomorrow. Is it better to have a high or low deductible runs the numbers.
When you compare plans, look at the deductible, the out-of-pocket maximum and the premium together. Prices for similar coverage also differ between insurers, so check several companies. If keeping costs down is the main goal, see the cheapest ways to get health insurance. And if you’re wondering whether you could skip insurance and pay as you go, what if you can afford your medical bills out of pocket looks at the risks.
Compare deductibles and premiums side by side: see plans in your ZIP code.
Frequently asked questions
Do my premiums count toward my deductible?
No. Premiums keep your coverage active. Only what you pay for covered care counts toward the deductible.
What happens after I meet my deductible?
You pay copays or coinsurance until you reach your out-of-pocket maximum, then the plan pays 100% of covered in-network care for the rest of the year. See what an out-of-pocket maximum is.
Do prescriptions count toward the deductible?
Usually, when the drug is covered and subject to the deductible. Some plans have a separate drug deductible or charge flat copays for generics.
What if I can’t pay my deductible?
Your coverage continues, but you’ll owe the provider. See what happens if you can’t pay your health insurance deductible.
Sources
This article is general information, not insurance advice. Deductibles and covered services vary by plan, so check your plan’s summary of benefits or ask your insurer. Last reviewed September 2026.