There are quite a few medical services that are covered on a typical Arizona health insurance policy that do not require having to meet the policy’s annual deductible first. Per federal law, Affordable Care Act (ACA) well-care visits such as physicals must be covered at no charge to the policyholder. Most ACA policies cover office visits and urgent care visits with a co-pay, no deductible.
Confusion may arise when different health services require different deductibles be met first before the health insurance company pays. As examples, emergency room visits likely have a separate deductible or co-pay to meet if not admitted, as well as using an out-of-network provider. These deductibles and co-pays can be in the hundreds of dollars, or more.
It is common today to have a separate pharmacy deductible. Some plans accumulate all claims against an aggregate annual deductible. Other plans allow in-network claims to count toward an out of network deductible. In the case of Blue Cross and Blue Shield of Arizona, an individual family member can meet an individual deductible as opposed to having to meet the family deductible. This is known as an embedded deductible. This is very helpful financially when only one member of family has claims in a given year.
The Medicare Part A deductible in 2022 is $1556 per benefit period (as opposed to an annual deductible.) The Medicare Part B deductible is $233 in 2022. Medicare Advantage plans (Medicare Part C) have several different deductibles. Some have $0 deductibles, but you pay co-payments on most services. Medicare Part D (prescription coverage) have an annual deductible no larger than $480.
Because there are so many different deductibles for so many different services and situations, it is highly recommended that you create and use an online account on your health insurance company’s website. Through such an account you can see how deductibles are applied and your plan is structured. Nobody is perfect and mistakes are made when it comes to crediting out of pocket payments to deductibles and keeping a watchful eye on such matters may save you more than a few dollars.