Insurance Deductibles Begin Anew in Barely 10 Weeks – Is Your Business Ready?

For professionals depending on commercial health insurance to pay the bulk of their session time with clients, the first few months of each calendar year can be rough.

If an insured or “member” (i.e. your client) has a deductible, which most plans do, that means the entire cost of session visits must be paid by that client until the deductible is met.

If the client has no other health issues or reasons to see another professional, it can mean weeks or even months before his or her insurance kicks in. For clients with high deductible health plans, it could even mean the client might go an entire year just paying down that deductible.

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. Source: (A quick search was unable to find the definition of “high deductible” for 2021.)

Considering many insured patients of my own clients have deductibles that are $3,500, $5,000 or more, a $1,400 deductible doesn’t seem “high” to me.

Anyway, an old report (from April 2011, Medical Expenditure Panel Survey) states that in 2009, 73.8% of private sector employees had a deductible of $917.00 for an individual (and double that for a family) along with a co-pay.

Let’s assume that the average deductible has stayed the same as it was in 2009 (ha!). This means that if you’re charging $150 per session, it would take your patient or client at least 6 sessions of out-of-pocket payments before her insurance kicks in. (I am greatly oversimplifying this, but to describe all the scenarios would make for dreadfully tedious reading.)

It’s now mid-October and I’m working with my professional clients to start planning with their patients for January 2021, when that new deductible hits.

If you need help in this area, give me a call at 207-740-2247.

Categories: Insurance

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