Deductible

A deductible is the dollar amount you have to pay out-of-pocket for covered services before your health insurance plan begins paying for your care.

How does a deductible work?

Let's say your plan has a $1,500 deductible. Each month, you'll pay your premium (opens in new tab) to Oscar to maintain your health coverage. You get some care for free with your Oscar plan, like phone calls with doctors in the Oscar app and preventative care (opens in new tab), like an annual physical and flu shot. When you go to the doctor, hospital, therapist, etc. you'll pay for the first $1,500 of care you need. Just remember to stick with doctors in our network.

If I'm paying for my own care, why have insurance?

When you have a health plan and visit a doctor in our network you won't pay full price for care. You'll pay Oscar's negotiated rate (opens in new tab), which can be 10-60% below what you would pay if you didn't have insurance. You're also getting credit for these charges, and you can track your progress in the Oscar app. Once your spending reaches your deductible, you'll start paying much less. And if your spending reaches your out-of-pocket-max (opens in new tab), you won't spend anything more on covered health care as long as you get care with doctors in our network.

Why is it good to have a deductible?

In general, the higher your deductible, the lower your premium. If you don't usually need a lot of health care during the year but want some basic coverage in case of an emergency, having a less expensive health plan with a high deductible and paying as-you-go for health care can help you save hundreds of dollars a month.

But if you are managing a chronic condition (opens in new tab) or have a planned procedure coming up, a more expensive health plan with a low deductible could lower your costs in the long run.

What's the deal with family deductibles?

If you have a family health insurance plan, your family deductible (opens in new tab) is two times the individual deductible, and the family out-of-pocket max (opens in new tab) is two times the individual max. However, family deductibles work a bit differently than individual deductibles.

On a family plan, individual deductibles still come into play if one person needs a lot more care than everyone else on the plan. If one person reaches their individual deductible, your family plan will start covering more of their care (usually in the form of coinsurance (opens in new tab) or copays (opens in new tab)). If other family members need care after someone in the family reaches their individual deductible, you'll pay for covered care (opens in new tab) until you hit the remaining balance on your family deductible.

To learn more about how family deductibles work, and see if a family plan is right for you, check out this article (opens in new tab).