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In a few months I'm switching to a health insurance plan with a $1,600 deductible. After the deductible is met, the plan pays everything, i.e. 0% coinsurance.

As of now, I see a physical therapist each week at a cost of $250. Under the new plan, will I have met my deductible after seven visits (because 7 * 250 > 1600)? Or is the charge for each doctor/therapist visit counted separately, and so the deductible is never met because the cost each week is less than 1600.

All of the examples of deductible math I can find online refer to a single bill, e.g. "Michael has a deductible of 1600 and is billed 5000 for medical care, so he pays 1600 and then the coinsurance rate kicks in for the rest." What I can't figure out is how the deductible works when there are a bunch of separate, smaller doctor visits, each of which is less than the deductible.

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    The answer you received below is correct, but one other thought, since you mentioned PT. Many insurance plans specify limits on number of PT visits. You might want to check yours before assuming that all of your visits after the 7th are paid for - you might find that after X visits, you are suddenly responsible for payment again. – dwizum Sep 16 at 16:53
  • @dwizum Great point. I have definitely experienced the limits on the number of PT visits; thanks for mentioning that. That was the best example I could think of off the top of my head for "not insanely expensive ongoing medical care" but it wasn't necessarily the best one. – Michael A Sep 16 at 18:00
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Doesn't matter if it's one doctor's visit or many.

A $1,600 deductible means you're fully responsible for the first $1,600 of medical costs in that year. Once you've spent $1,600, insurance kicks in and covers part or all (depending on your plan) of the remainder.

Your seventh PT visit would see insurance assist with the last $150.

  • Thanks for the info. After I saw your answer I finally found an article that talked about this too. – Michael A Sep 14 at 19:23

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