FAIR Health Consumer Access

Spring Cleaning for Your Deductible

Spring is here. Now could be a good time to review the deductible on your health plan. Warmer weather and longer days can help you feel more energized and make you more likely to prioritize your health. One important element of your health plan is your deductible. A deductible is the amount of money you must pay each year before your health plan starts sharing the cost of most covered services. After you reach your deductible, your health plan will pay a share of your healthcare costs.

Understanding your deductible now can help you plan ahead and avoid unexpected bills. Think of it as spring cleaning for your deductible.

How Does a Deductible Work?
Until you reach your deductible, you usually pay the full plan-approved cost for healthcare services. These services can include lab tests, specialist visits, imaging (such as X-rays or MRIs) and certain procedures.

It’s a good idea to check your plan to see how your specific deductible works. Different health plans have different deductible amounts, and they can change each year. Also, some health plans have both individual and family deductibles. If you have a family health plan, it may start covering services for one of you after that individual meets their deductible. Or it may only start covering services after the full family deductible is met.

If you change your health plan partway through the year, you will likely get a new deductible. And you’ll have to meet the whole of the new deductible for your new plan to start sharing your costs. But preventive care is usually covered fully. Therefore, it doesn’t typically count toward your deductible.

Find out more about health plan cost sharing in our article Cost Sharing: Know What You May Owe. And find out more about deductibles and health plans in our articles Choosing a Health Plan and High Deductible Health Plans.

Why You Should Check Your Deductible Status
Most health insurance deductibles reset on January 1, meaning what you paid last year no longer counts. Checking now, in the spring, helps you see how close you are to meeting your deductible. Then you can plan the best timing for future appointments. You can also estimate costs for spring and summer and avoid unexpected bills.

How to Check Your Deductible Progress
To check your deductible balance, log in to your plan’s member portal. You can also review your plan documents there and keep track of your healthcare expenses.

Here’s another way to check your deductible progress. After you get a healthcare service, check the explanation of benefits that your plan sends you. That will let you know what’s been billed to your provider and your plan’s allowed amount. It will also let you know how much your plan paid and what you owe. Checking that against your online portal will confirm what’s been applied to your deductible. Don’t be shy about speaking up if you find a discrepancy. The number to call is on the back of your insurance card.

If You’re Close to Meeting Your Deductible
Are you close to meeting your deductible? Then you might save money by scheduling services now, such as specialist visits, imaging, physical therapy and procedures your provider already recommended. If there’s an elective procedure you’ve been waiting to get, remember that your plan will pay more for your care after you’ve met your deductible. In fact, pursuing as much care as possible after meeting your deductible and before it resets at the beginning of the year can be a good way to manage your deductible.

Just make sure your provider bills for your care promptly. If the bill doesn’t get processed until the next year, it’ll be subject to your new deductible.

If You’re Far from Meeting Your Deductible
You can expect to pay more for your healthcare services until your deductible is met. Keeping that in mind can help you plan which services to prioritize and avoid unexpected bills. Remember, preventive care is usually covered with no cost to yourself—even if you haven’t met your deductible. If you need care and you haven’t met your deductible, you can still save money by only using in-network providers.

By checking your deductible now, you can plan better, stay ahead of unexpected costs and feel more confident about your healthcare choices.