You have decided to pick the same plan for your entire family – either directly with the insurance company, through your work, or through the Federally Facilitated Marketplace. That’s probably a wise decision, but now you’re confronted with the question: ‘How does the family deductible work?’
That’s a very good question, and the short answer is that ‘it depends.’
There are 2 types of deductibles – embedded and unembedded.
Embedded deductibles – no individual family member will contribute more than the individual deductible / maximum out of pocket to the family deductible / maximum out of pocket.
Example – $1000 individual / $2000 family deductible with 100% coverage after the deductible. Family member has $2500 of care, they are responsible for the $1000 toward the deductible and the insurance company would pay the rest of the bill.
Unembedded Deductibles – The entire family deductible must be met prior to the insurance company paying for qualifying care.
Example – $1000 individual / $2000 family deductible with 100% coverage after the deductible. Family member has $2500 of care, they are responsible for the $2000 toward the family deductible and the insurance company would pay the rest of the bill.
Given the potential intricacies of a family plan, it is important to understand how the specific options you are considering will work as it pertains to your specific situation. This blog is meant to be general and educational, as such, it is important to learn the specifics of your policy.
If you would like to continue this conversation or if you have questions, please contact us or call 717.637.3670.
At Webb Insurance we don’t give tax or legal advice. This blog should not be taken to be tax or legal advice. We help people find the appropriate health insurance.