# Health Insurance Deductible - Yet $0 Routine Physical? **URL:** \ **Category:** Factual Questions\ **Created:** [October 29, 2009, 8:28pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652 "2009-10-29T20:28:27Z")\ **Posts on this page:** 10\ **Page:** 1
**Author:** ![Polly\_Glot](https://avatars.discourse-cdn.com/v4/letter/p/9de053/32.png) [@Polly\_Glot](https://boards.straightdope.com/u/Polly_Glot)\ **Post date:** [October 29, 2009, 8:28pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/1 "2009-10-29T20:28:27Z")
I just received my family’s spanking new health insurance cards - we haven’t all been covered as one unit in many, many years. Even though we have a “deductible” of 2k per person/4K as a family, my cards do note our member co-payments for various services, including $0 for a routine physical, $25 for a well child care visit, etc. I did read our (excrutiatingly poorly-written) member benefits booklet, but couldn’t find an answer to these questions: Say I call my doctor and set up a routine physical as my first service on the insurance. Am I paying the actual cost of the appointment (given that it would probably be less than 2K), or am I paying nada? Is the deal that the deductibles are for the actual co-pays themselves - say, once I have paid the deductibles’ worth of co-pays for the usual type of medical visits, then any further visits are basically free? (Does that last question even make sense?!?) Thanks in advance for any/all replies. It’s been many years since my hubby and I have had any sort of health coverage, and I can hardly afford the full cost of a doctor’s visit right now! ---
**Author:** ![Shot\_From\_Guns](https://avatars.discourse-cdn.com/v4/letter/s/ccd318/32.png) [@Shot\_From\_Guns](https://boards.straightdope.com/u/Shot_From_Guns)\ **Post date:** [October 29, 2009, 8:41pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/2 "2009-10-29T20:41:00Z")
Caveat: My plan is not your plan. Call the number on your insurance card and ask someone there. With the plan I currently have, I pay nothing my normal yearly checkups (all-over physical and GYN stuff), and the cost that is covered by my insurance company does not apply toward my deductible. So, say that the visit would cost $500 and I have $1,000 left on my deductible: I pay nothing, my insurance pays $500, and my deductible is still at $1k. ---
**Author:** ![dracoi](https://avatars.discourse-cdn.com/v4/letter/d/90db22/32.png) [@dracoi](https://boards.straightdope.com/u/dracoi)\ **Post date:** [October 29, 2009, 8:49pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/3 "2009-10-29T20:49:05Z")
Yeah, you have to call your insurer if the benefits booklet doesn’t make it clear. In shopping around a couple of years ago, I saw plans that: 1. had a co-pay and a deductible. So the co-pay was due whether they were going to cover there st of the cost or not. 2. had a co-pay for certain wellness benefits that was often two to four general check-up appointments per year. The insurance paid for these whether you’d reached your deductible or not, as a way to encourage you to keep regular check-ups. ---
**Author:** ![Polly\_Glot](https://avatars.discourse-cdn.com/v4/letter/p/9de053/32.png) [@Polly\_Glot](https://boards.straightdope.com/u/Polly_Glot)\ **Post date:** [October 29, 2009, 8:52pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/4 "2009-10-29T20:52:27Z")
Absolutely, **Shot From Guns** - I should just call the number on the card but I have had my kids and their friends literally running throughout the house for hours now and can’t concentrate on the spoken word in the meantime. I suspect that my plan would work similarly to yours, then. Thanks! ---
**Author:** ![Polly\_Glot](https://avatars.discourse-cdn.com/v4/letter/p/9de053/32.png) [@Polly\_Glot](https://boards.straightdope.com/u/Polly_Glot)\ **Post date:** [October 29, 2009, 8:58pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/5 "2009-10-29T20:58:27Z")
> [@dracoi](#): > > Yeah, you have to call your insurer if the benefits booklet doesn’t make it clear. In shopping around a couple of years ago, I saw plans that: > > 1. had a co-pay and a deductible. So the co-pay was due whether they were going to cover there st of the cost or not. > 2. had a co-pay for certain wellness benefits that was often two to four general check-up appointments per year. The insurance paid for these whether you’d reached your deductible or not, as a way to encourage you to keep regular check-ups. Oh yes, I’ve noticed that those “Health Insurance for One” plans, at least, manage to encompass a mish-mash of deductible/co-pay requirements; my new plan, however, is from my employer, so no shopping around was necessary on my own initiative. 🙂 With any luck I’ll be able to reach someone after business hours to clarify (as a teacher, I can’t call during the day). ---
**Author:** ![SmackFu](https://avatars.discourse-cdn.com/v4/letter/s/53a042/32.png) [@SmackFu](https://boards.straightdope.com/u/SmackFu)\ **Post date:** [October 29, 2009, 9:15pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/6 "2009-10-29T21:15:10Z")
My health insurance specifies everything as being either “no deductible” or “after deductible”. Which is a very important distinction. Office visits for example have no deductible, so we pay only 15% of the bill from the start. That 15% does not count against the deductible, but does apply to the out-of-pocket maximum. OTOH, hospital visits are specified as after deductible, so we pay 20% of the bill after the first $700 or so. So your plan details may vary, but generally I would hope preventative care would be in the “no deductible” category. Otherwise the low co-pays wouldn’t really be much of a motivation to get those things done. ---
**Author:** ![Polly\_Glot](https://avatars.discourse-cdn.com/v4/letter/p/9de053/32.png) [@Polly\_Glot](https://boards.straightdope.com/u/Polly_Glot)\ **Post date:** [October 29, 2009, 9:29pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/7 "2009-10-29T21:29:06Z")
> [@SmackFu](#): > > **My health insurance specifies everything as being either “no deductible” or “after deductible”. Which is a very important distinction.** > > Office visits for example have no deductible, so we pay only 15% of the bill from the start. That 15% does not count against the deductible, but does apply to the out-of-pocket maximum. > > OTOH, hospital visits are specified as after deductible, so we pay 20% of the bill after the first $700 or so. > > So your plan details may vary, but generally I would hope preventative care would be in the “no deductible” category. Otherwise the low co-pays wouldn’t really be much of a motivation to get those things done. Aye, that is indeed a very important distinction. Now that you mention it, many of the benefits listed on my plan state “$(insert astronomically high number here) after deductible.” Others, such as the aforementioned routine physical, don’t say anything at all about any potential effect on the deductible. Thus my confusion. :smack: ---
**Author:** ![dracoi](https://avatars.discourse-cdn.com/v4/letter/d/90db22/32.png) [@dracoi](https://boards.straightdope.com/u/dracoi)\ **Post date:** [October 29, 2009, 11:23pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/8 "2009-10-29T23:23:20Z")
> [@Polly\_Glot](#): > > Oh yes, I’ve noticed that those “Health Insurance for One” plans, at least, manage to encompass a mish-mash of deductible/co-pay requirements; my new plan, however, is from my employer, so no shopping around was necessary on my own initiative. 🙂 > > With any luck I’ll be able to reach someone after business hours to clarify (as a teacher, I can’t call during the day). Actually, I was shopping for a group plan (myself, my wife, and two employees at the time). I intentionally picked one that was simpler at least in part so that employees didn’t have to remember all the details. ---
**Author:** ![Polly\_Glot](https://avatars.discourse-cdn.com/v4/letter/p/9de053/32.png) [@Polly\_Glot](https://boards.straightdope.com/u/Polly_Glot)\ **Post date:** [October 29, 2009, 11:51pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/9 "2009-10-29T23:51:55Z")
> [@dracoi](#): > > Actually, I was shopping for a group plan (myself, my wife, and two employees at the time). I intentionally picked one that was simpler at least in part so that employees didn’t have to remember all the details. Details + an ADHD-addled brain\*, such as I seem to have, don’t tend to mix too well. I hope your employees appreciated your selection. \*My heretofore undiagnosed ADHD is a big reason why I feel a need to visit the doctor in the first place. I thought my being scatterbrained, inattentive, and easily distracted were just the way I was made. But then I had my kids, who themselves have ADHD, which is when I realized th… ooh look! A kite! ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [October 30, 2009, 10:48pm UTC](https://boards.straightdope.com/t/health-insurance-deductible-yet-0-routine-physical/515652/10 "2009-10-30T22:48:25Z")
Obviously plans vary - but as others have said, I’d bet routine stuff is all covered with a per-visit copay (or in the case of preventive care, it’s free). My plan this year has a deductible - but office visits aren’t subject to that at all. The deductible would apply to things like procedures (surgery etc.), equipment (my new orthotics), and probably a few other things. Preventive care is covered 100% - my mammogram and the kids’ well-child visits were free.