What is a deductible?
The number everyone mentions but rarely fully explains.
You know the basic idea. This guide goes further — the different types of deductibles, what actually counts toward yours, and how to track your progress through the year.
Show me the deductible types ↓Quick recap
A deductible is what you may pay for covered services before your plan starts paying its share. Need the basics and a dollar example? See the full breakdown → — this page goes deeper into the details that trip people up.
Three ways deductibles vary
Your plan may combine several of these at once — check your plan documents for your specific structure.
Who it applies to
An individual deductible applies to one person. A family deductible is a shared total — some plans use "embedded" individual amounts within the family total, others require the full family amount to be met together.
Which providers count
Many plans track these separately, often with a higher out-of-network deductible — care from an out-of-network provider generally doesn't count toward your in-network deductible.
What type of service
Some plans have one combined deductible for everything; others track a separate pharmacy deductible for prescriptions.
What counts toward your deductible?
Preventive care is often different
Many plans cover certain preventive services — like annual checkups and specific recommended screenings — at no cost before your deductible is met. This isn't universal, so confirm which specific services qualify under your plan.
Most other services — office visits, tests, procedures — generally do count toward your deductible unless a copay applies instead.
Tracking your progress through the year
Example only — illustrating how progress toward your deductible works over a plan year.
Your EOBs and member portal both generally show running totals — check either one before assuming what you'll owe for a new service.
Where patients get tripped up
"My deductible resets whenever I want."
It generally resets at the start of each new plan year — not on the anniversary of when you first used it.
"My family deductible is 4x my individual one."
Not necessarily — family deductible amounts vary by plan design, not just simple multiplication.
"Once I switch plans mid-year, my progress carries over."
Generally not — a new plan usually means starting your deductible over, even mid-year.
"All preventive care is free."
Many preventive services are, but not every service — confirm the specific list for your plan.
In Canada? Deductibles mostly apply to a different layer of coverage.
Jump to the Canadian guide ↓Mostly a private-plan concept
For core medically necessary doctor and hospital care, provincial/territorial public health insurance generally doesn't use a deductible. Deductibles are far more common on the private or workplace benefits layer — for things like prescription drugs, dental, and vision — and work similarly to the concepts on this page.
What are you trying to do?
See the full cost-sharing breakdown
Read the guide →Check if a service is covered
Read the guide →Read my EOB
Read the guide →What is coinsurance?
Understanding out-of-pocket maximums
Resolve an insurance problem
Browse the Hub →Common questions about deductibles
Does my premium count toward my deductible?
No — your premium is separate from your deductible. Only what you pay for actual care generally counts.
What happens once I meet my deductible?
Coinsurance (or copays, depending on your plan) generally take over from there, until you reach your out-of-pocket maximum.
Do all family members share one deductible?
Depends on the plan — some use one shared family deductible, others use "embedded" individual deductibles within it. Check your specific plan.
Can I find out my current deductible balance anytime?
Generally yes — your insurer's member portal or app usually shows a running total, and you can also call customer service to confirm.
Know your number. Track your progress.
Checking your deductible balance before a visit can save you from an unexpected bill.