Glossary
Deductible
The amount you must pay out of pocket each year for covered health services before your insurance plan starts to pay.
Last updated: May 11, 2026
A deductible is the amount you must pay out of pocket each year for covered health services before your insurance plan starts to pay.
If your deductible is $3,000, you pay the first $3,000 of covered medical bills yourself (at the plan’s negotiated rate). After that, the plan starts covering its share — usually most of the cost, with you paying a copay or coinsurance until you hit your out-of-pocket maximum.
Examples
- You have a Silver plan with a $3,000 deductible. You go to urgent care and the negotiated rate is $200. You pay the full $200 because you have not met the deductible yet.
- Later in the year, you have surgery that costs $15,000. You pay the remaining $2,800 of your deductible, then the plan starts paying coinsurance (let’s say 80/20) on the next $12,200.
Deductibles by metal tier (typical for 2026)
- Bronze: $6,000-$8,500
- Silver: $3,000-$5,500 (or much lower with Cost-Sharing Reductions)
- Gold: $1,000-$2,500
- Platinum: $0-$1,000
What does not count toward the deductible
- Free preventive services (annual checkup, vaccines, screenings) are covered before the deductible.
- Copays on plans that have pre-deductible copays for primary care or generics are usually not counted toward the deductible.
- Out-of-network care often counts toward a separate, higher deductible — or not at all.
Family vs individual deductible
If you have family coverage, you may have an individual deductible per person AND a family deductible. Once one person hits their individual deductible OR the family hits the family deductible, the plan starts paying for that person.
How to lower your deductible
- Pick a Silver plan if you qualify for Cost-Sharing Reductions (income under 250% FPL). CSR can drop a Silver deductible from $5,000 to $500.
- Pick a Gold or Platinum plan. Lower deductible but higher monthly premium.
- Use a Health Savings Account (HSA) with an HSA-eligible Bronze plan if your deductible is high but you want to save pre-tax for medical costs.
Related terms
Talk to a licensed agent — they will compare deductibles across plans in your zip code for free.