What Is a Deductible? How Health Insurance Deductibles Work in 2027

Updated October 2026 for the 2027 plan year

What is a deductible and how does it work?

The simplest answer to “what is a deductible” is a threshold. Until your payments for covered care reach it, you pay the plan’s negotiated rate for most services yourself. Once you reach it, the plan begins to share the cost for the rest of the plan year.

Here is the order of events for a typical Marketplace plan:

1. You get covered care. The doctor or hospital bills your insurer.
2. The insurer applies its allowed amount. That is the negotiated price for an in-network provider, and it is usually lower than the billed charge.
3. You pay the allowed amount until your yearly payments reach the deductible.
4. After the deductible, you pay a coinsurance percentage or a copay and the plan pays the rest.
5. At the out-of-pocket maximum, the plan pays 100% of covered, in-network care until the plan year ends.

The deductible resets at the start of each plan year. Marketplace plans run on the calendar year, so a 2027 plan’s deductible starts over on January 1, 2027, no matter how much you spent in 2026.

What counts toward a deductible?

Payments you make for covered, in-network services usually count toward your deductible. Premiums, care your plan doesn’t cover, and most out-of-network bills do not. The exact rules are in your plan’s Summary of Benefits and Coverage.

Copays are the confusing row. A flat copay paid before the deductible always counts toward your out-of-pocket maximum, but some plans don’t credit it toward the deductible itself.

What is covered before you meet your deductible?

Preventive care is the big exception. Under the Affordable Care Act (ACA), Marketplace plans must cover a set of preventive services, such as many screenings and immunizations, with no copay or coinsurance when you see an in-network provider, even if you haven’t met your deductible.

Many plans also cover other services, like a checkup, before the deductible, often with flat copays for primary care, urgent care or generic drugs. Look for the phrase “deductible does not apply” in the plan details.

What types of deductibles are there?

Most plans list more than one deductible in their summary. Asking “what is a deductible for this bill?” before you get care prevents surprises.

• Individual deductible: applies to one person’s covered care.
• Family deductible: applies to the combined spending of everyone on the plan.
• Combined deductible: one deductible covers both medical care and prescription drugs.
• Separate drug deductible: prescriptions have their own, usually smaller, deductible.
• In-network and out-of-network deductibles: PPO and POS plans that cover out-of-network care often set a separate, higher deductible for it. HMO and EPO plans generally cover no out-of-network care except emergencies (see HMO vs PPO vs EPO vs POS).

How does a family deductible work?

Family plans often have both an individual deductible for each person and a family deductible for everyone combined. How they interact depends on whether the plan uses an embedded or an aggregate deductible.

There is also a federal safety net. HHS has clarified that the self-only out-of-pocket limit applies to each person on a family plan, so no single family member pays more than the individual cap in a year, which is $12,000 for 2027 (CMS ACA FAQ Part XXVII). Our deductible vs out-of-pocket maximum page walks through the family math.

How do deductibles differ by metal tier?

Marketplace plans come in Bronze, Silver, Gold and Platinum tiers. Lower tiers usually pair lower premiums with higher deductibles, and higher tiers do the reverse. The tier tells you the average share of costs the plan pays, not the exact deductible.

Source: HealthCare.gov health plan categories. If your household income is up to 250% of the federal poverty level, a Silver plan with cost-sharing reductions can lower your deductible sharply. See Bronze vs Silver vs Gold vs Platinum for a full comparison.

What is a high deductible health plan?

A high deductible health plan (HDHP) is a plan whose deductible meets an IRS minimum and whose out-of-pocket costs stay under an IRS maximum. Being enrolled in one is what lets you put pre-tax money into a health savings account (HSA).

For 2027, the IRS sets the HDHP minimum deductible at $1,750 for self-only coverage and $3,500 for family coverage (Rev. Proc. 2026-24). An HSA lets you save tax-free money to pay the deductible and other medical costs.

The rules widened in 2026. Under IRS Notice 2026-5, Bronze and Catastrophic plans available as individual coverage through an Exchange are treated as HSA-compatible for months after December 31, 2025, even if they don’t meet the usual HDHP test. Learn more in what is an HSA.

Is a high or low deductible better?

Neither is better for everyone. A high deductible usually means a lower premium and more risk if you get sick. A low deductible usually means a higher premium and more predictable costs when you use care.

• A higher deductible can fit if you are generally healthy, rarely use care beyond preventive visits, and have savings or an HSA to cover a bad year.
• A lower deductible can fit if you take regular prescriptions, manage a chronic condition, or expect a surgery or a baby.
• Either way, add a year of premiums to the out-of-pocket maximum to see your worst case. Our guide on how to choose a health plan shows the steps.

Premium tax credits lower your premium, not your deductible. That is why a subsidized Gold plan can sometimes cost little more each month than a Silver plan. Check your savings on health insurance subsidies for 2027.

Frequently asked questions

Keep learning: health insurance terms A–Z, what is a premium, what is coinsurance, how health insurance works and open enrollment 2027.