Understand your costs

You deserve high-quality care and services — not financial surprises. Here’s what you need to know to understand your costs better. 

How a deductible works

With a deductible plan, you pay the full cost for many services until you reach a set amount for the year — your deductible. After you reach your deductible, you’ll usually start paying just a copay or coinsurance:

•  A copay is a set amount you pay for a service.
•  A coinsurance is a percentage of the full cost of a service.

Those payments and your deductible payments count toward your out-of-pocket maximum.¹ Your out-of-pocket maximum helps protect you financially if you get sick or injured. If you reach your out-of-pocket maximum, you won’t have to pay for most covered services for the rest of the year. 

How a deductible works for a family plan

Depending on your plan, you may have one of the following:

• One family deductible for your whole family 
• A family deductible, and an individual deductible for each person in your family

Whenever a covered family member pays for qualified care, it counts toward your family deductible. Once you’ve reached your family deductible, everyone on the plan starts paying a copay or coinsurance instead of the full cost of services.

Many family plans also have an individual deductible for each family member — in addition to the family deductible. If one family member reaches their individual deductible before the family deductible has been met, they’ll start paying a copay or coinsurance for services before the rest of the family.

What you owe with a deductible plan

Chart showing what you’ll pay for preventive care before and after your out-of-pocket maximum has been reached.

Chart showing what you’ll pay for nonpreventive care before and after your deductible and out-of-pocket maximum have been reached.

Estimate your costs

Our cost estimates tool can help you plan for health care costs ahead of time. Your estimates are based on your plan details and how much you’ve paid toward your deductible and out-of-pocket maximum — so you get personalized information every time.

To learn more about your plan, you can:

• Sign in to your account and click “Benefits” 
• Call the number on your medical bill or Kaiser Permanente ID card

Our treatment fee tool can provide a general estimate of the most common medical exams, tests, and procedures, without taking your personal benefit information into account.

What to expect at your visit

You may be asked to pay before, during, or after your visit. Here’s what you can usually expect:

• When you check in, you’ll be asked to make a payment for most scheduled services.
• During your visit, you might get services you didn’t schedule, like X-rays or blood tests. These could have extra costs.
• After your visit, you’ll get a bill if the total cost of your care is more than what you paid at your visit.

Keep in mind that if you have an HRA, HSA, or FSA administered through Kaiser Permanente, your payment experience could vary. And if you need help paying your bill, we offer payment plans and financial assistance.

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© 2019 Kaiser Permanente

¹Your copay experience may vary by region. Check your Evidence of Coverage for more details.