How deductible plans work
All 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 and all our deductible plans offer preventive care services – like routine physical exams, mammograms, and cholesterol screenings – at no cost or just a copay, depending on your plan.
Understanding deductible plans
When you get care, you'll pay the full charges for covered services until you reach a set amount known as your deductible. After you reach your deductible, you'll start paying less – just a copay or a percentage of the charges (a coinsurance) for the rest of the year.
Full charges, copays, and coinsurance count toward your out-of-pocket maximum, which helps limit how much you pay for care. After you reach your maximum, you won't have to pay for covered services for the rest of the year.
Depending on your plan, you may pay copays or coinsurance for some services without having to reach your deductible. For example, most preventive care services are always covered at a copay or at no cost. Any payments for these services also count toward your out-of-pocket maximum.
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 preventive medical 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 and keep 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 you have a family plan, you have a deductible and out-of-pocket maximum for your whole family as well as for each individual. After you reach your family deductible, everyone in your family will pay copays or coinsurance for covered services, even if they haven’t reached their individual deductible. And if you reach your family out-of-pocket maximum, no one in your family will pay for covered services for the rest of the year.
If you have an HSA-qualified plan, your family’s deductible and out-of-pocket maximum may work differently.