How does my deductible plan work?
If you have a plan with a deductible, you may be a little unsure about how it works or what the benefits are. We’re here to help you make the most of it.
Getting to know your deductible plan
A deductible plan means you’ll be required to pay a specific amount of out-of-pocket cost (the deductible) before your insurance comes in to pay some of your claim. But with a little know-how on your part and a bit of help from us, you'll find the true value they can offer.
You’ll pay a deductible, but your premium cost can be lower than other plan types.
Compare Costs Before You Go
Being a savvy shopper pays off. Comparing prices for services before you go means you can get more for your dollar.
Options to Save
If your employer offers a health financial account with your medical plan, you can save on taxes and help pay for your out-of-pocket health care expenses.
No-Cost Preventive Care
Things like routine health checkups, immunizations, certain screenings, and other preventive care are included in your plan.
Add some savings to your spending
You might have some great options to boost the financial power of your deductible plan with a financial account. Depending on your employer and plan choice, smart planning and smart shopping can really pay off.
Health Savings Account (HSA)
You can contribute pre-tax dollars and even invest your savings to help pay for medical, dental, vision, and other qualified expenses, now or later in life. Learn more about HSAs.
Flexible Spending Account (FSA)
You can set aside pre-tax dollars from your paycheck to be used toward qualified out-of-pocket health expenses. It’s an easy way to save. Learn more about FSAs.
Health Reimbursement Arrangement (HRA)
Your employer helps cover your health expenses by contributing tax-free funds you can use toward out-of-pocket medical costs. Learn more about HRAs.
Make the most of every dollar!
Here are our pro tips to becoming a savvy consumer of health care. We’ll help you plan with tools to estimate prices, and give tips for squeezing every bit of savings from your benefits.
Use your Health Financial Account
When you deposit pre-tax dollars to a health financial account, your taxable income is reduced. This means that every dollar you put into your account stretches an average of 30 percent further.
Boost your energy, and your savings
Your plan likely offers fitness and weight-loss reimbursements, plus savings on many healthful self-care and holistic activities. So be sure not to leave any dollars on the table.
Estimate Costs In Advance
To better manage your out-of-pocket dollars, use our Find a Doctor and Estimate Costs tool to understand in advance what to expect and consider alternatives. Sign in to MyBlue before starting your search, to be sure your results are in our network, and to avoid cost surprises.
Let’s lay it all out
When it comes to your plan, let’s start with your deductible.
A deductible is the amount you pay toward your health care before we come in to pay some of your claims.
So if your deductible is say, $1,000, you’ll have to pay $1,000 in medical costs, like lab tests, x-rays and hospital stays.
Then we’ll share some of the costs with you.
Depending on your plan, sharing costs might be called a co-pay or co-insurance.
Either way, you’ll only pay a portion of your bill, and we’ll pay the rest.
The good news is preventive stuff like routine checkups and vaccines are no cost, even before you meet your deductible, so take advantage of that!
Got it? Great! All you have to do now is sign in to MyBlue or download the MyBlue app to keep tabs on your medical tab and stay two steps ahead.
Here’s the crash course
on deductible plans.
How do they work? How do we share costs with you? And what’s covered even if you don’t meet your deductible? We lay it all out.
Hands-On Health Care FAQs
It’s the amount you pay for medical expenses each plan year before Blue Cross Blue Shield of Massachusetts begins to pay.
If you haven’t yet met your deductible, you’ll likely pay for diagnostic services like these:
- X-rays and imaging
- Tests, for example: a Strep test if you have a sore throat, cholesterol tests, testing a polyp discovered during a colonoscopy
- Lab tests and bloodwork
- Surgery (inpatient and outpatient)
- CT scans
- Monitoring your blood sugar quarterly
If you have a Saver plan, you’ll also pay full price for prescription drugs until you meet your deductible. Remember, things like routine health checkups, immunizations, certain screenings, and other preventive care are included in your plan. Learn more
It’s the most you'll pay in a plan year for covered health expenses before Blue Cross pays 100 percent of covered expenses for the rest of that year. The money you pay for your deductible and prescriptions counts toward your medical or pharmacy out-of-pocket maximum.
Once you meet your deductible, you may have to pay for a portion of your covered services, and we’ll pay for the rest.
It’s about knowing how your numbers work together: your deductible, your premium, and any financial account funds at your disposal. If you keep aware of these and then use our cost estimator tool to know in advance what procedures and doctors are charging, you can stay on top of cost surprises and better manage out-of-pocket expenses.
Sign in to MyBlue or create an account to see all your numbers in one place