I often receive questions from people who say they went to the doctor but their visit wasn’t paid for by their insurance, or their prescriptions weren’t covered. These people want to know why they are paying for health insurance if it isn’t going to cover anything.
In most cases, the answer is that they haven’t yet met their deductible. Many plans cover doctor’s visits and prescriptions, but only after the patient has paid first. If your plan has a deductible, it means that you will pay out-of-pocket for expenses up to that amount, and then insurance will kick in.
So let’s say, for example, that you have a $250 deductible with your insurance plan. You may have to pay out-of-pocket for doctor’s visits or copays until your total expenses reach $250. To be clear, that doesn’t mean $250 per instance. You may pay $60 for a prescription in January, $30 for another in February, and so on. All of those expenses get totaled—in this example you are up to $90. Once you have paid a total of $250, your insurance will kick in and cover your expenses for the rest of the year.
These costs usually reset at the beginning of the year. Hello, January. Early in the year, you may be paying out-of-pocket, but as the year goes on and you meet your deductible, your insurance may start paying on your behalf.
As you budget for the year, you may want to keep these expenses in mind. In fact, you may want to set aside some extra money each month toward the end of the year to cover your out-of-pocket costs at the beginning of the next year. You may also consider opening a flexible spending account (FSA) or health savings account (HSA) in the future to help cover your out-of-pocket costs.
