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In the past, I have had individual health insurance. If I had a $1000 deductible, that meant that I had to pay the first $1000 of my health expenditures each year.

Next year, I expect to have a family health insurance policy. Suppose that I purchase a policy with a $1000 individual / $2000 family deductible. Suppose that in January next year, I have a surgery that costs $1500. Then, in February, my wife has a surgery that costs $1500.

How should I expect to be billed for the first surgery and the second surgery?

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When you have $1000 individual and $2000 family, and the family consists of you and your wife - you'll see no difference.

If, however, you happen to have a kid - then consider this:

  1. You had a surgery in February, billed $1500, paid $1000 deductible, insurance covered $500.

  2. Your wife had a surgery in May, billed $1500, paid $1000 deductible, insurance covered $500.

  3. Now comes the kid and breaks his hand playing soccer in the park. You take him to the ER, get billed $20000. You pay 0 since you exhausted your $2000 family deductible on your and your wife's surgeries.

  • So basically, the two deductibles work separately. When one member of the family needs healthcare, the expense counts toward the individual deductible for that member, but once the family deductible has been reached, the individual deductible is no longer relevant? – Rice Flour Cookies Oct 30 '14 at 16:48
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    @RiceFlourCookies yes. Some policies don't have both, you either have the individual one or the family one. – littleadv Oct 30 '14 at 18:22
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How the deductibles work depends on the policy. On the policies provided by the insurance I have, you either have a family deductible in effect or a single deductible, but not both.

Because I have family coverage on my policy (I am paying family premiums), here is how it would work with the insurance I have:

  1. You have a $1500 surgery. You pay all of it, and it is applied to your $2000 family deductible. You haven't met your deductible yet.

  2. Next your wife has a $1500 surgery. You pay $500, and then your deductible is met, and insurance kicks in from there.

With some policies, if you have family coverage, you can ignore the single deductible number. You'll need to ask your insurance provider how the deductibles work for your policy.

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    I have a policy that has both individual and family deductibles. And for this provider (which is very common and is considered one of the best in the area where I live) I haven't seen anything else. – littleadv Nov 3 '14 at 7:46
  • @littleadv I guess it depends on the policy, then. – Ben Miller Nov 3 '14 at 11:46

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