Deductibles

Definition

A deductible is the amount an individual must pay out-of-pocket for healthcare services before their insurance coverage begins to provide benefits. It is a feature of insurance policies that requires the policyholder to bear a portion of the financial responsibility for their medical expenses.

5 Must Know Facts For Your Next Test

1. Deductibles are designed to incentivize policyholders to be more conscious of their healthcare spending and to seek cost-effective medical services.
2. The level of the deductible can impact the premium, or monthly cost, of the insurance policy, with higher deductibles typically resulting in lower premiums.
3. Deductibles can vary widely across different types of insurance plans, such as health, auto, or homeowner's insurance, and may be applied annually or on a per-incident basis.
4. Policyholders must carefully consider their anticipated healthcare needs and financial situation when selecting an insurance plan with an appropriate deductible level.
5. Preventive care services, such as annual check-ups and screenings, are often exempt from the deductible requirement and covered at 100% by the insurance provider.

Review Questions

• Explain how deductibles are used in the context of insurance and imperfect information.
  • Deductibles are a feature of insurance policies that address the problem of imperfect information in the healthcare market. By requiring policyholders to pay a portion of their medical expenses out-of-pocket before insurance coverage kicks in, deductibles incentivize individuals to be more discerning consumers of healthcare services. This helps to mitigate the moral hazard associated with insurance, where individuals may be more likely to overconsume healthcare services if they do not bear the full cost. Deductibles also serve to screen out low-risk individuals who are less likely to file claims, allowing insurance providers to offer lower premiums to policyholders.
• Describe how the level of a deductible can impact the cost of an insurance policy.
  • The level of a deductible is inversely related to the premium, or monthly cost, of an insurance policy. Policyholders who are willing to accept a higher deductible, and thus bear a greater portion of their medical expenses out-of-pocket, will typically pay lower premiums. Conversely, those who prefer a lower deductible, and thus have the insurance provider cover a larger share of their healthcare costs, will generally pay higher premiums. This trade-off allows insurance providers to offer a range of policy options that cater to the varying risk preferences and financial situations of their customers.
• Analyze how the use of deductibles in insurance policies can help address the problem of information asymmetry between policyholders and insurance providers.
  • Deductibles in insurance policies help address the problem of information asymmetry between policyholders and insurance providers by aligning the incentives of both parties. When policyholders are required to pay a portion of their medical expenses out-of-pocket before insurance coverage begins, they are more likely to be discerning consumers of healthcare services and seek cost-effective options. This helps to mitigate the moral hazard associated with insurance, where individuals may be inclined to overconsume healthcare services if they do not bear the full cost. Additionally, deductibles serve as a screening mechanism, as they tend to deter low-risk individuals from filing claims, allowing insurance providers to offer lower premiums to their customer base. By sharing the financial responsibility between policyholders and insurance providers, deductibles help to address the information asymmetry and create a more efficient healthcare insurance market.

Related terms

Coinsurance: Coinsurance is the percentage of healthcare costs that the policyholder must pay after meeting their deductible, with the insurance provider covering the remaining percentage.

Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount a policyholder must pay for covered healthcare services in a given time period, after which the insurance provider covers 100% of the remaining costs.

Copayment: A copayment is a fixed amount the policyholder must pay for a specific healthcare service, such as a doctor's visit or prescription, regardless of the total cost of the service.