A deductible is the amount of money you will have to pay out of pocket each year for health care before your insurance company starts paying its share. Deductibles can vary from nonexistent to more than $4,000 a year. In general, plans with lower premiums (such as Bronze plans) have higher deductibles, and vice versa.
What you need to know if you have a high one:
The insurance company will pay for certain services even before you have met the deductible.
All insurance plans (except a few that existed before the health law was signed in March of 2010), must pay in full for preventive health services no matter whether you have met the deductible or not. Here's a list of those services.
Some plans may cover services that carry a copay (a fixed dollar amount) from day one of the plan, even if you have not met the deductible. That means that even if you haven't had any other medical care, you might only have to pay a $25 copay for a doctor visit that costs $100. Consult your plan documents to find out whether your plan works this way. It can sometimes be hard to tell, even with the help of the standardized Summary of Benefits and Coverage. If you are not sure, contact the insurance company's customer service department and ask.
Once you have this information, try to use these pre-deductible services to get your care. For example, if you have a sore throat, go to a doctor's office, which charges a copay, rather than the emergency room, which you will likely have to pay for in full unless you have met your deductible.
Not all health providers charge the insurance company the same, so look up prices if you can.
Insurers negotiate prices with individual hospitals, medical practices, laboratories and other providers. Insurers often can bargain down prices more successfully with some providers than others. If you have not met your deductible, going to a lower-cost provider can save you hundreds or occasionally thousands of dollars.
Do not waste your time calling up the provider to ask the price. Providers can participate with dozens of plans and may have no way of knowing what yours pays them before you file the claim.
But the insurance company will know. Many health plans now enable members to look up some prices online. You must register at your insurer's website to use this service. If the health care procedure or service you are looking for is not listed on the website, call the insurer directly. Be aware, though, that some hospitals and doctors do not allow insurance companies to disclose their fees to plan members in advance.
Savings can be substantial. In a Connecticut city we looked at, a major insurer was paying nearly $3,600 more for an uncomplicated vaginal delivery at the most expensive hospital than at the cheapest one.
If the service you need doesn't involve a hospital stay (examples would be lab tests, X-rays, and walk-in surgery), you will almost always find a better price if you avoid going to the hospital for the service. CT scans and colonoscopies can be done at either kind of place but can cost more than five times as much at hospitals than at clinics or doctor's offices.
You can save on some drugs by NOT using your insurance
Several drugs that used to be available only with a prescription can now be bought over-the-counter, without a prescription for a much lower price. They include drugs for heartburn, insomnia, joint pain, migran headaches, seasonal allergies, and insomnia.
You can get some generic drugs for as little as $4 a prescription at Sam's Club, Target, and Walmart. That's probably less than your insurance copay.
Here are details on this advice and more tips on how to save money on prescription drugs.