Deductibles and Out-of-Pocket Maximums

2020 and 2021 Plan Year Information

Annual Deductibles and Out-of-Pocket Maximums

When choosing a Medical Plan option, it’s important to consider total costs. It’s easy to just look at your paycheck contributions or the deductible amount and make a snap decision. But understanding your estimated total costs under each option is the best way to choose the right plan for your needs.

To do that, you first need to understand how the annual deductibles and out-of-pocket maximums work.

Your annual deductible is the fixed dollar amount you must pay each year toward your medical expenses before the Medical Plan begins to cover a portion of the cost of your health care services. You pay the full cost of services (with some exceptions, shown below) until you meet the total the deductible amount. After the annual deductible is met, you and the Plan share in the cost of services through coinsurance. If the sum of your deductible and out-of-pocket costs reaches the out-of-pocket maximum, the Plan begins to pay 100% of the cost of in-network services and 100% of reasonable and customary cost for out-of-network services for the remainder of the year.

When looking at your three Medical Plan options, the higher the deductible and out-of-pocket maximum, the lower your paycheck contributions will be, and vice versa.

Option AOption BOption C
Paycheck Contributions

Highest

Moderate

Lowest

Medical Deductible

Lowest

  • Individual: $500
  • Family: $1,250

Moderate

  • Individual: $1,000
  • Family: $2,500

Highest (medical + Rx drug)

  • Individual: $2,000
  • Family: $4,000
Prescription Drug Deductible

Lowest

  • Individual: $50
  • Family: $150

Lowest

  • Individual: $50
  • Family: $150

Highest (medical + Rx drug)

  • Individual: $2,000
  • Family: $4,000
Medical Out-of-Pocket Maximum

Lowest

  • Individual: $1,800
  • Family: $4,500

Moderate

  • Individual: $2,800
  • Family: $7,000

Highest (medical + Rx drug)

  • Individual: $5,000
  • Family: $10,000
Prescription Drug Out-of-Pocket Maximum

Lowest

  • Individual: $2,450 per person
  • Family: $6,125

Lowest

  • Individual: $2,450 per person
  • Family: $6,125

Highest (medical + Rx drug)

  • Individual: $5,000
  • Family: $10,000
Note

All amounts shown reflect in-network rates.

For Option C, if you are enrolled in family coverage, the true family deductible must be met before the Plan begins to pay benefits for you or your covered dependents.

 

Consider This

If you think you’ll need to receive a significant amount of care in next year, you may opt to pay more in paycheck contributions, in exchange for a lower deductible and out-of-pocket maximum. Or, if you don’t anticipate needing a lot of care next year, you may choose to pay less out of your paycheck, and more when you need care.

Important Rules About How the Deductible Works

All Medical Plan Options

You do not need to meet your medical deductible for in-network preventive care. Due to Health Care Reform, you pay $0 for in-network, age-appropriate services, such as annual physicals and certain cancer screenings.

Options A and B

If you choose Option A or B, you do not need to meet your prescription drug deductible for mail-order medications. You only pay the copay or coinsurance amounts.

Option C

There are two important distinctions regarding how the deductible works for Option C, because it is a Consumer-Driven Health Plan:

  • Combined Medical and Prescription Drug Deductible. For any non-preventive services and prescription drug costs, you must satisfy the full deductible and out-of-pocket maximum before you begin to pay coinsurance. So, if you are prescribed a non-preventive prescription drug early in the year, it is possible that you may have a substantial bill: up to $2,000 (single coverage) or $4,000 (family coverage).
  • True Family Deductible. With Option C, your family’s expenses must meet the full family deductible before the Plan begins to pay coinsurance. Under Options A and B, each individual member of your family need only meet the single deductible for his or her coinsurance to begin. This is called an “embedded” or “individual” deductible. Note that for all options, the out-of-pocket maximums are “embedded” or “individual”. Learn how the family deductible works.