Premium vs. Deductible

Nearly everyone has an insurance policy of one kind or another. There are many types of insurance coverage. The types of coverage include:

• Homeowners insurance
• Health insurance
• Auto insurance
• Life insurance

If you've ever shopped for an insurance policy, you've probably encountered the terms premium and deductible. But what do these terms mean? How do they impact each other? Read on to learn more about the distinctions between premiums and deductibles.

What Is a Premium?

An insurance premium is the amount of money that a person or a business pays in exchange for the coverage offered by an insurance policy. You may have options when it comes to how often you pay insurance premiums. Some policies allow you to make monthly installments, while others require annual or semi-annual payments.

At the end of your policy term, the amount of your premium might be increased. This can be due to several factors. If you submitted a claim during your insurance policy term, this may result in a future increase in your premium. Or, if the risks associated with your particular type of policy increase for some reason, your premium may also increase.

Failing to pay your premium will result in the cancellation of your policy. For example, your health insurance premium is $175 per month. To keep your health insurance coverage active, you will be responsible for paying this amount as required under the insurance contract.

Factors Influencing the Premium

Insurance companies rely on actuaries to determine the appropriate amount of a premium. They take all the relevant risk factors into account. Insurers use the premiums they collect to cover the liabilities associated with the policies they underwrite.

Frequently, insurance companies invest the premiums while retaining an adequate reserve to pay out claims. The dollar amount of your premium will depend on various factors. Factors influencing premiums include:

• The type of policy
• The likelihood that you will need to make a claim
• Where you live
• How many people are covered under the policy

An insurance agent can explain how different factors influence your specific premium for the policies you need to purchase.

What Is a Deductible?

A deductible is the set amount that you must pay each year (in addition to your premium) toward a loss or liability before your insurance company will start paying on your behalf. Your deductible starts over at the beginning of each year, and you'll have to meet your annual deductible again before insurance will begin to pay.

How Are Premiums and Deductibles Related?

The amount of your premium directly relates to the amount of your deductible. When shopping for an insurance policy, choosing the policy with the lowest premium may be tempting. However, a policy with a lower monthly premium will typically have a higher deductible.

A plan with a higher monthly payment and a lower deductible may be a better option, depending on your circumstances. When deciding on an insurance policy and deductible amount, it's helpful to consider how likely you are to use your insurance benefits.

Premiums and Deductibles in Health Insurance

Take health insurance, for example. With health care costs rising each year, most people need health insurance coverage for themselves and their family members. If you think it's unlikely that you will use your insurance often, consider a plan with a lower monthly premium.

A plan with lower premiums for health care coverage will result in a higher deductible. A high deductible plan will likely provide adequate protection for your medical expenses.

On the other hand, if you rely on insurance frequently, consider a higher monthly premium and lower deductible health benefit. For example, a higher monthly premium and lower deductible might work if you have a medical condition requiring frequent medical care.

How Does a Deductible Work in Health Insurance?

A policyholder must meet a deductible for covered services before the insurer will begin paying for the health care services. If you include a spouse or dependents on the plan, your insurance costs will be higher. You will pay a higher premium, and the deductible will be higher, too. When looking at deductibles, it's helpful to consider how much, in case of an emergency, you could pay out-of-pocket at any given point.

Suppose your health insurance plan has a $1,000 deductible, you must meet this amount before your insurance company will start paying your medical bills. If you incur an emergency room bill of $800, you will be responsible for paying this amount in full. That is considered an out-of-pocket cost. However, if you have an emergency surgery that costs $50,000, you will only be responsible for paying the first $1,000. Once you reach the out-of-pocket maximum, your insurance company will begin paying your medical bills.

Deductibles vs. Coinsurance vs. Copays

Deductibles are different than two other insurance terms: coinsurance and copays. The copay is the fixed amount you pay each time you receive benefits. Coinsurance, conversely, refers to your share (usually a percentage) of the cost of a covered service.

For example, your health insurance policy could have a $2,000 deductible, a $25 copay for each doctor's visit, and coinsurance requiring you to cover 25% of the cost of generic prescription drugs. A copay cost may be higher if you use an out-of-network provider. The plan's network often depends on your health insurance plan you have (e.g., HMO, PPO).

Get Legal Help With Premiums, Deductibles, and Other Insurance Issues

There are many issues to consider when shopping for insurance. You may already have an insurance policy. If you have a conflict related to premiums, deductibles, or any other insurance issue, you may want to seek legal counsel. FindLaw can help you find an experienced insurance law lawyer in your area. They can explain your legal options.