How to handle a high health insurance deductible
A frame from Netflix’s ‘Beef’ movie.
Courtesy: Netflix
In the new season netflix In the comedy-drama “Beef,” Ashley, played by Cailee Spaeny, is hospitalized with an ovarian cyst. The waiting area is dreary, with gray decor and filled with patients who look as if they’ve been trapped there for years. Ashley’s partner Austin, played by Charles Melton, returns from the reception desk with some bad news: “You’ve got a super high discount – $5,000,” Austin says.
“Wow. Can we drop $5,000?” Ashley says. “What if it costs less? Do they give us the difference?”
“Kind of the opposite,” Austin replies.
This is true – your exemption It is the amount you must pay before your health insurance kicks in. But the Emmy-winning series’ second season, which premieres April 16, underscores widespread confusion. According to a 2024 report, just over 1 in 4 of Gen Z adults could define the term insurance as “deductible.” questionnaire From the National Association of Insurance Commissioners.
“Proponents argue that waivers make people more careful consumers of health care by avoiding unnecessary care,” said Miriam Straus, associate director of the Center for Health Law and Policy at Georgetown Law’s O’Neill Institute.
“But many consumers may not realize that they could be facing thousands of dollars in health care costs with a high-deductible plan,” Straus said.
Straus added that research shows that unaffordable deductibles can also worsen health outcomes. For example, he said: “High-deductible health plan coverage among cancer patients, worse overall survival”
How common is the $5,000 rebate?
In the ’90s and early 2000s, many health insurance plans didn’t even come with deductibles, said Matthew Rae, deputy director of KFF, a nonpartisan health policy research organization. Today, that has changed: About 88% of workers with employer-sponsored insurance qualify for a deductible, compared with just 55% in 2006, Rae said.
As medical services expanded and costs rose, employers and insurers turned to deductibles to restrict use and reduce their own expenses. Between 2005 and 2020, “we saw a rapid increase in exemptions,” Rae said. While this growth has slowed recently (largely because employers realize high costs can make plans completely unattainable), stability could be at risk if the labor market weakens further and cost pressures increase, he added.
“A $5,000 discount wouldn’t surprise me at all,” Rae said.
Netflix Beef: Season 2
Source: Netflix
Some are Affordable Care Act Marketplace plans There may be deductibles that exceed $7,000, most people pay less. The average market deductible in 2026 is $2,912, compared to $1,881 in 2014.
Meanwhile, KFF research shows that deductibles for those with employer-provided coverage have increased 17 percent in the past five years and 43 percent in the past decade. Rae said roughly 1 in 5 of those workers have a single coverage deductible of $3,000 or more.
“Even if it’s not $5,000, that puts a huge financial burden on people,” Rae said. “It’s a shock to your budget.”
What should you do about your health insurance deductible?
There are several ways to determine your deductible, said Caitlin Donovan, senior director of the National Patient Advocate Foundation.
“This could be on your insurance card and it could be in your benefit disclosures,” Donovan said. “If you have a patient portal, you should be able to log in and find it there and know how far you’ve come to meet it.”
If you still can’t find it, call your insurance company and ask, he added.
If meeting your deductible seems daunting, remember that “hitting your deductible isn’t necessarily a goal,” says Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation.
Because of the protections outlined in the ACA, some preventive services with in-network providers should be covered at no charge whether you meet your deductible or not, Hempstead said. Lists of protected treatments and tests are available at: healthcare.gov. Some examples include vaccinations, lung cancer screening, birth control, and typically your annual physical exam.
If you’re young and healthy and rarely use your insurance, you may not need to meet your deductible, Donovan said.
But on the other hand, if you have a chronic illness or high medical expenses, you may want to increase your deductible at the beginning of the year so you can tap into your coverage later, he said. If you can, schedule your most expensive services, such as surgery, after your deductible is paid and your coverage is in full effect, Donovan said.
A high-deductible plan often comes with a health savings account, flexible spending account or a health reimbursement arrangement, he added. All three of these tax-advantaged accounts can make paying for your care a little less burdensome.
“Sometimes you have to be a little crafty,” he said.
If you haven’t reached your deductible yet and are worried about your upfront costs, do some research before booking a service or exam, said Patricia Kelmar, senior director of health care campaigns at consumer advocacy group PIRG.
“Laboratory and imaging prices can vary greatly,” Kelmar said. “You can usually get a quote in advance from your insurer.”
Try to avoid hospital examinations because they facility feeshe added. Kelmar said if you are offered a discount when you pay cash for a service, that discount is not deductible.
A $5,000 discount wouldn’t surprise me at all.
Matthew Rae
Deputy director at KFF
Kelmar said it’s also a smart idea to regularly review your progress toward paying your deductible. You can often see these details in your insurance provider’s portal.
“There can sometimes be delays if your provider has not yet submitted claims,” he said. “If you’ve had care recently, check to see if you’re getting what you paid out of pocket.”
