Kaiser – Deductible Plans

Kaiser deductible plans

All our deductible plans offer the quality care and services you expect from Kaiser Permanente. You get a wide range of programs and tools to help you stay in control of your health and all our deductible plans offer preventive care services – like routine physical exams, mammograms, and cholesterol screenings – at no cost or at a copay, depending on your plan.

Understanding deductible plans

When you get care, you’ll pay the full charges for covered services until you reach a set amount known as your deductible. After you reach your deductible, you’ll start paying less – a copay or a percentage of the charges (a coinsurance) for the rest of the year.

Full charges, copays, and coinsurance count toward your out-of-pocket maximum, which helps limit how much you pay for care. After you reach your out-of-pocket maximum, you won’t have to pay for most covered services for the rest of the year.

Chart describing deductible plans

Depending on your plan, you may pay copays or coinsurance for some services without having to reach your deductible. For example, preventive care services are always covered at no cost or at a copay. Copays and coinsurance for services that are not subject to the deductible also count toward your out-of-pocket maximum.

Chart describing deductible plans

Learn more about your plan

If you’re not sure which deductible plan you have, check your Evidence of Coverage or call the number on your Kaiser Permanente ID Card.

Deductible HMO Plan – Hospital Services
Deductible HMO plan – Preventive Care Services and Doctor’s Office Visits
Deductible HMO plan – Preventive Care Services
Deductible HMO plan with HRA
HSA-Qualified Deductible Plan
Other Benefits

How a deductible works for a family

If you have a family plan, you have a deductible and out-of-pocket maximum for your whole family, as well as one for each family member. If a family member reaches his or her individual deductible first, he or she will start paying copays or coinsurance (instead of the full charges) before the rest of the family. After you reach your family deductible, everyone in your family will start paying a copay or coinsurance for covered services, even if they haven’t reached their individual deductible.

If you reach your family out-of-pocket maximum, no one in your family will pay for most covered services for the rest of the year. And if anyone in the family reaches their individual out-of-pocket maximum before the rest of the family, they won’t have to pay for most covered services for the rest of the year.

If you have an HSA-qualified plan, your family’s deductible and out-of-pocket maximum may work differently.