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.
- Deductible — a set amount you need to reach each calendar year before you start paying copays or coinsurance for most services covered by your plan. You’ll pay the full charges for most services until you reach your deductible.
- Copayments (copays) — fixed dollar amounts you pay for certain services covered by your plan. For example, if you had a $10 office visit copay, you’d pay $10 for each office visit.
- Coinsurance — a percentage of charges you pay when you receive certain services covered by your plan. For example, if you had a 30 percent coinsurance for hospitalization, you’d pay 30 percent of the charges for covered hospital services.
- Out-of-pocket maximum — the maximum amount you’ll pay in a calendar year for most services covered by your plan. Most copays, coinsurance, and deductible payments apply toward 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 to you, even before you reach your deductible. This helps you detect problems before they become serious, so you're better able to keep living life to the fullest.
Learn more about preventive care services. Also, find out when a preventive care visit might include non-preventive services that involve additional costs.
How a deductible works for a family
If your family is covered under your plan, you’ll typically have two types of deductibles and out-of-pocket maximums 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.
If a family member reaches his or her individual deductible
If a family reaches its family deductible
The out-of-pocket maximum works in a similar way, for individuals and the family as a whole. When the individual or family out-of-pocket maximum is met, we’ll pay for most covered services for the individual family member or the entire family for the rest of the calendar year. Most copays, coinsurance, and deductible payments apply toward your out-of-pocket maximum.