What Does 100% After Deductible Mean?

What Does 100% After Deductible Mean?
Some health plans only have deductibles for hospital care or emergency services.

Deductible Basics

Deductibles are common on many types of insurances, including home, auto, health and dental. On a health insurance policy, for instance, you might have a $500 annual deductible for hospital admissions. With a home policy, deductibles often range from $250 to $2,000. Full-service auto policies include deductibles on both collision and comprehensive coverage at varying amounts. With dental insurance, deductibles are normally around $25 to $75.

Co-Insurance Basics

The 100 percent amount in the phrase "100 percent after deductible" references a co-insurance structure. Co-insurance is shared obligations between the insurer and the covered member on service fees. With a 100 percent after-deductible benefit, you have no co-insurance. Another common co-insurance format is 80/20. This co-insurance level means that your insurance company pays 80 percent after deductible, and you pay 20 percent. If the post-deductible balance is $2,000, for instance, you pay $400 and the insurer pays $1,600.

Claims Process

When you go to the hospital for a planned surgery, the facility normally sends you a statement noting what you owe on the appointment date. If your health provider pays 100 percent after deductible, and your deductible is $500, your statement would indicate that you owe $500. If the total bill is $5,500, the insurance provider picks up the remaining balance of $5,000. In contrast, on an 80/20 co-insurance plan, you would owe $500 plus 20 percent of $5,000, which is an additional $1,000.

Other Considerations

Some people have health policies with deductibles that vary between in-network and out-of-network providers. Your insurance company might pay 100 percent after deductible on in-network benefits, for instance, but pay 80 percent of after deductible expenses for out-of-network care. Policies often have out-of-pocket maximums as well, which means that even if you don't have 100 percent after deductible coverage, you may have a cap on how much you have to spend each year.