What is a deductible in health insurance?

When contracting a major medical expenses policy, analyze what type of insurance is best for you, according to your age, risks and income; see if it is more convenient to hire a high premium and a low deductible, or vice versa.

The physical activities you do daily, your work life and type of work, the area where you live, transport routes, susceptibility to genetic diseases, age, are aspects that you should evaluate when choosing a Major Medical Expenses Insurance policy. (SGMM) and the corresponding deductible.

Rubén Martínez, a finance academic from UNAM, explained that the contracting of this type of insurance will depend on an analysis that people carry out about their lives and risks.

The policy grants the right to the sum insured and payment of the deductible is made in the event of an accident. The higher the premium amount, the lower the deductible payment and vice versa.

According to Condusef, The deductible is the amount from which the insurer begins to pay the amount of the claim so that the company will not pay for accidents or illnesses whose care or treatment implies an amount less than this. It is the first payment that is distributed and is made by the insured.

To choose the best insurance, Martínez recommended considering the possibility of being hospitalized and added that if there are few risks in the social environment where the subject to be insured lives or is young -generally, the younger there is, the lower incidence of health risks- , what is convenient is a low-cost policy that does not cover too many claims, and a high deductible.

If an incident occurs to an insured person, they will have to pay the deductible plus the coinsurance, a percentage paid by the insured that is applied to the total amount of the expenses covered by the medical expenses insurance once the first concept has been deducted. He checks that the coinsurance has a ceiling or cap.

Silvano García, director of the Legacy insurance consultancy, explained that people with risks, who are older and susceptible to contracting a hereditary disease, will have to do the opposite, acquire a high policy that provides extensive coverage for claims but with a higher deductible. low , since the incidence risks of being hospitalized during the coverage period will be higher.

He said that the applicants of this type of insurance should check if their company has not put a limit on the application of the deductible, as some insurers condition a minimum amount to eliminate it. García recommended that people who want to contract this compensation seek an advisor who knows the information on the variety of products and branches of the different insurers.

Also, in the case of high deductibles, check how many times you have to pay it when you suffer from chronic illnesses or those with recurring consequences, because insurers can charge it only once in a lifetime, once a year or per event.

The consultant said that the amounts of both deductibles and coinsurance will depend on the company and all the clauses included.“The standard cost of coinsurance is 10 percent of the cost of the service that the hospital will provide, but the limit depends on each company, on the category of the hospital (the higher the level, the higher the limit), and in the case of international policies, on whether it is scheduled. hospitalization or not,” he noted.


The deductible. You can choose the amount, just like the premium; consider that the younger, the first may be higher because the risks are lower.

Evaluate. As you get older, the premium payment grows and the deductible goes down since with age the risks increase.

Choose. You can pay the insurance with a card, monthly without interest.

Saving. Having an extra sum for any claim, it will serve to pay the deductible and coinsurance in case it happens.

Evaluate. The costs of the coinsurance, deductible, and annual policy, as well as the hospitals involved, if the coverage is national and/or abroad and the sum insured.

Leave a Reply

Your email address will not be published. Required fields are marked *