Family Deductibles Made Simpler

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.’

Let’s start with a traditional type of plan.  Each member of the family would incur expenses, and once a single family member hit the individual deductible, that individual would then be subject to co-insurance if that’s a feature of the plan.  The rest of the family members would continue to pay medical expenses toward their deductible, and once the total spend for the family reached the family deductible, then everyone would be in co-insurance.  No single individual can satisfy the family deductible.

Example – Traditional Plan:

Family plans with $1000 individual deductible/$2000 family deductible.  Dad spends $1000 on medical care, he receives the rest of his care with the co-insurance after the deductible (if applicable).  Mom and child each spend $500 on care, the total family spend is now $2000 toward the deductible, and everyone is in co-insurance for the remainder of the year.

Example – Qualified High Deductible Health Plan (QHDHP):

The family plan has a $2500 individual deductible/$5000 family deductible.  In this case, assuming a family of at least 3, the individual deductible is irrelevant.  The family needs to satisfy the entire family deductible of $5000 before co-insurance would apply to the plan.

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.

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