Can someone please explain what EXACTLY a health insurance deductible is/means?

I am really confused about what a deductible is (regarding health insurance). I am new to the insurance thing. My new policy has a $500 deductible. I assumed this meant that I would have to pay the doctor the full price out of pocket until the deductible is met, but when I went they only charged me the co-pay. And I had only had the insurance for a few weeks. Is this normal?
My boyfriend, on the other hand, just got a new policy (different company) through his job. He got sick and wanted to go to the urgent care, but the policy said that first of all, he would have to pay a certain percentage of the cost assuming that it really was considered "urgent". Why did he not just have to pay his co-pay? Is it different for urgent care?
Can someone please explain the deductible thing?
Thanks for any help!

Your boyfriend had to pay because for emergency services, you must meet some/all of your deductible in case surgery, imaging services, etc are incurred but for regular visits/check-ups you only pay your copay because you will not be needing surgery, x-rays, etc.

It is different depending on the type of doctor visit and it also differs between insurance companies. Generally, if you just see the doctor, you just pay the copay. But if you have any lab work (blood tests, xray etc) or any procedures (stiches, brace etc) then you pay some of the deductible as well.

Every policy is different. Insurance companies don't want anyone to be able to compare plans, apples to apples, as the saying goes.

Urgent care and the emergency room is usually subject to the deductible and co-insurance, and often has an addition fee that you pay as well.

Deductible
A deductible is what you have to pay before your health insurance kicks in. This is a pre-set amount per year. Some times the deductible is for the whole family, sometimes times two or 3 family members. Check the policy.

Co-Insurance
You will pay the deductible first, then you will pay a percentage of the costs, until you reach the a maximum out of pocket expense, per year

For example, a common policy has a $1,000.00 deductible and a 70/30 co-insurance with a maximum out of pocket of $5,000.00.

Suppose you are hospitalized and the total bill comes to $20,000.00. You will pay your $1,000.00 deductible before your health insurance pays a dime. After that, you will pay 30% of the bill until you have paid your maximum out of pocket expense of $5000.00. Your health insurance company then pays for the rest.

Note: Some plans do not have a co-insurance. Also, the deductible does not always apply to the maximum out of pocket. Check your health insurance policy for details.

Co-pay
Traditional polices allow you to go to a doctor, and get prescriptions for a pre-determined price. A co-pay is not subject to the deductible or co-insurance, nor does the co-pay apply towards the deductible & co-insurance.

Don
http://mtnhealthinsurance.com

Your agent should explain this for you but some of the answers you're getting here are correct. Many policies allow office visits with a small co-pay even before you reach your deductible.

If your boyfriend is paying for his group coverage he should shop for an individual policy like you did. He may save a lot of money.

It is the amount you have to pay (typically annually) before the insurance starts to pay. Just because the doctor's office assumed you have no copay at the time of your visit doesn't mean that you won't end up getting billed for it. Doctor's offices' "front desk" employees are notoriously incompetent when it comes to insurance and billing matters.

It's the amout you have to pay, before the insurance kicks in. Sometimes, it's not applied to office visits, only to an ER visit, or hospital STAY.

Health insurance is NOT standardized, so your BEST source of information, is the number on the back of your card.

Hi, I have done a lot of medical billing, both for doctors and hospitals. The yearly deductible is the amount of out-of-pocket money you must pay before the insurance will pay on the amount charged by any doctor or hospital. Co-pays are the money you must pay up-front to access the doctor and/or tests being done for you. The co-pays you pay will reduce your deductible.
Say you go to the doctor and your co-pay is $20. You pay that amount out of your own pocket. Then the doctor's medical biller will bill your insurance company for their charge. Say the charge is $70. The insurance company (in most cases) will pay only an "allowed" percentage on the charged amount. Say they would normally "allow" $60 for that visit to the doctor. The statement they send you will tell you that $40 (that they would have paid) is applied to the deductible that you still have to pay, and that you are responsible for $20 (the co-pay) and the remaining $10 will be a "write-off" by the doctor. (Insurance companies have agreements with each doctor that accepts that insurance, and they almost all include some "write-offs".) Somewhere on the statement, they should tell you that the $20 co-pay that you are responsible for will be deducted from your "deductible for the year", as well as the $40 they allowed for the doctor, but which you must pay out-of-pocket until you have reduced your deductible to $0. If your deductible is $500, you have just reduced the deductible by $60, leaving you $440 that you must still pay out of pocket before the insurance company will pay anything. (The insurance company has no responsibility for whether or not you pay the doctor. Whatever you still have to pay out-of-pocket is between you and the doctor.)

Urgent care facilities work just the same as a regular visit to a doctor, except the charge may be slightly more because they are available on a walk-in basis. Otherwise, the insurance works just the same as a regular doctor. Urgent care facilities are for people who need to see a doctor right away (meaning they can't wait until regular office hours), or perhaps they don't have a regular doctor, or are out of town. Urgent care is down-scale from emergency rooms at hospitals, and handle anything that a person needs to have a doctor take care of, from a sore throat, cut finger up to possible severe problems, in which case, the urgent care doctor will send them to a hospital emergency room, by ambulance if necessary.

Some insurances (a LOT of them now!) require co-pays, but some insurances don't have co-pays, instead they have policies where you pay a percentage of the doctor's charge instead, after the insurance pays. Some insurances (like mine) require co-pays on some things (doctor's visits) and not co-pays on others (tests) where you pay a percentage. Some of them require co-pays on treatments, and others require you to pay a percentage, after the insurance pays. In all these cases, you will have to ALWAYS pay the required co-pay up-front, and until the yearly deductible is met (and reduced to $0) you will have to pay whatever the insurance tells you on their statement you must pay the doctor. Make sure what the doctor's statement says matches what the insurance statement says you must pay. After you pay your co-pay and leave the doctor's office, always wait to pay the doctor until AFTER you receive the insurance statement letting you know what you are responsible for. If something looks wrong, call the insurance company for clarification.
Very important is that you read your insurance policy manual to understand what they cover, and what they don't. Sometimes they require either referrals from your PCP (Primary Care Physician) for specialists, or that you contact the insurance company for permission for treatment (especially at urgent care or a hospital E.R.)
Hope this all helps.

You understand it properly. When you have a copay SOMETIMES the copay is in lieu of the deductible and sometimes it doesn't come into play until after you've met the deductible. It depends on the policy you have.

So for you the visits will be covered by a copay but likely your lab and xray (assuming done outside the office) and also surgeries, etc... will all be subject to the deductible.

Hope that helps.

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