Deductible plans

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A guide to getting the most from your health plan

Life is unpredictable. Your health care costs shouldn’t be. From copays to coinsurance, get to know the basics of your deductible plan and how to use it.
 

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Understand your costs

Get an idea of what you’ll pay so you can plan ahead and avoid surprises.

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Use your HRA, HSA, FSA

Take advantage of tax-free savings on qualified health care expenses.

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About your bill

Learn how to read your bill, understand what you owe, and make a payment.

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Glossary

Get to know common health care terms related to your deductible plan.



 Health plan basics

How does a deductible plan work?

You pay the full cost for certain services until you reach a set amount for the year — your deductible. After you reach your deductible, you typically just pay a copay or coinsurance. With some plans, you may pay a copay or coinsurance for certain services even before you reach your deductible.*

The cost of your visit depends on your plan, the care you need, and how much you’ve paid toward your deductible and out-of-pocket maximum. Before your visit, you can get a personalized cost estimate to help avoid surprises.

Your copay or coinsurance depends on many factors, including your plan details, how much you’ve already paid for care, and the type of care you receive. To learn about your plan’s copay or coinsurance details, sign in to kp.org.

The amount you may pay at check-in might not cover everything you owe. That’s because your care team doesn’t know exactly what you need until they talk with you. You could receive a bill after your visit if:

  • You received additional services, such as lab tests or X-rays
  • What you paid didn’t cover the full cost of your scheduled services

Preventive care — like flu shots, mammograms, and routine physical exams — is covered at no cost or at a copay. But sometimes you need nonpreventive care during the same visit. For example, if you came in for a checkup and discussed an unrelated injury, your doctor might order an X-ray for it. You’d get a bill for the X-ray because it’s not preventive.


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© 2019 Kaiser Permanente

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