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How deductible plans work


All of our deductible plans offer the quality care and services you expect from Kaiser Permanente. You get a wide range of programs and tools to help you stay in control of your health. Let’s look at the basics of how deductible plans work, starting with some key terms. For details about your plan, you may be able to access your Evidence of Coverage at kp.org/document or call the number on the front of your Kaiser Permanente ID card to request a copy.

  • Deductible — The amount you pay for covered services each year before Kaiser Permanente starts paying. Depending on your plan, you may pay copays or coinsurance for some services without having to reach your deductible.
  • Copays —  The set amount you pay for covered services. For example, a $10 copay for an office visit.
  • Coinsurance — A percentage of the charges that you pay for covered services. For example, a 20 percent coinsurance for a $200 procedure means you pay just $40.
  • Out-of-pocket maximum — The most you’ll pay for covered services each year. For a small number of services, you may need to keep paying copays or coinsurance after reaching your out-of-pocket maximum.

  • Get an overview of how paying for care works with a deductible plan.

A focus on prevention


We believe preventive care is a great way to help you stay healthy. That’s why all our deductible plans offer most preventive care services — like routine physical exams, mammograms, and cholesterol screenings — at little or no cost, even before you reach your deductible. This helps you detect problems before they become serious and keep you from living life to the fullest.

Learn more about preventive care services. Also, find out when a preventive care visit might involve non-preventive services that require additional costs.


How a deductible works for a family


If your family is covered under your plan, you’ll typically have two types of deductible and out-of-pocket maximum that work together. 

  • Each family member has an individual deductible and an individual out-of-pocket maximum.
  • The family as a whole has a family deductible and a family out-of-pocket maximum.

If you have an HSA-qualified plan, your family’s deductible and out-of-pocket maximum may work differently.

Each family member has an individual deductible and an individual out-of-pocket maximum


If a family member reaches his or her individual deductible, that family member will start paying coinsurance for services covered by your plan for the rest of the plan/calendar year. All other family members will keep paying full charges for covered services until they reach their individual deductible or the family deductible is met.

The family as a whole has a family deductible and a family out-of-pocket maximum


If a family reaches its family deductible, all covered family members will start paying coinsurance for covered services for the rest of the plan/contract year — even if they haven’t all reached their individual deductibles.

When the individual or family out-of-pocket maximum is met, we'll pay for the medical service that apply to the out-of-pocket-maximum for the family member or entire family for the rest of the calendar year.

To learn more about which type of deductible and out-of-pocket maximum you have, click on the links for your plan.