What Does 100% After Deductible Mean?

Health insurance is essential to protect yourself against the financial burden of unexpected medical expenses, but you might still pay for a percentage of the cost of treatment depending on the terms of your plan. A deductible is an upfront cost that you must pay toward expenses before an insurance company will cover costs. If a plan covers 100 percent after the deductible, it means you do not have to pay any more after you meet the deductible.

How Deductibles Work

• Deductibles exist in many types of insurance plans, including health, auto and home policies. For health insurance, deductibles are usually annual limits that you contribute toward over the course of a year. For instance, you might have a health plan with a $5,000 deductible on surgical care that covers 100 percent of costs after the deductible. If you have a small operation early in the year that costs $4,000, you would have to pay the full $4,000 yourself because you have not yet met the deductible for the year. If you get another $4,000 procedure later in the same year, you would have to pay $1,000 to meet your annual $5,000 deductible and then the insurance company would cover the remaining $3,000. The insurance company would pay for any subsequent procedures you have during the year.

Coverage Limits

• Even if an insurance plan says it covers 100 percent after the deductible, you may still end up owing money if the cost of your expenses exceeds your insurance limits. An insurance limit is a maximum benefit that an insurance company will pay out. For example if your health plan had a $100,000 limit and you had a very costly cancer treatment, you might exceed the limit; you have to pay costs that exceed your insurance limits out of your own pocket.

Coinsurance

• Some health insurance plans require coinsurance, which means you share the cost of care with the insurance company. For example, a plan with 20 percent coinsurance on surgery would require you to pay 20 percent of the cost of surgery. If a plan states that it covers 100 percent after the deductible, it means you do not have to pay coinsurance.

Considerations

• Insurance plans vary in terms of what types of expenses are covered and to what extent. Some plans might have different deductibles for care you receive from certain medical providers and certain types of care might require coinsurance while others may not. For example, a health plan might cover 100 percent of the cost of surgery after the deductible, but you might have to pay coinsurance or flat fees called co-pays on other types of care.