What Is an Aggregate Deductible & How Does It Work?

Your health insurance aggregate deductible affects the entire family. Image ©Elizabeth Pollard-Grayson/Moment Collection/Getty Images

An aggregate deductible is the system most high-deductible health plans use for family deductibles. It works differently than the more common embedded deductible system used in non-HDHP health insurance.

How Does an Aggregate Deductible Work?

With an aggregate family deductible, the health plan doesn’t begin paying for the health care expenses of anyone in the family until the entire family deductible has been met.

Once the aggregate family deductible has been met, health insurance coverage kicks in for the entire family.

There are two ways the aggregate deductible can be met:

  1. As each member of the family uses and pays for health care services, the amount they pay out-of-pocket for those services is credited toward the family’s aggregate deductible. After several family members have paid deductible expenses, the combined total of those expenses reaches the aggregate deductible. The health plan then begins to pay the health care expenses of the entire family.
  2. One member of the family has high health care expenses. The amount he or she pays out-of-pocket for those expenses is large enough to meet the family’s aggregate deductible. The health plan then begins to pay the health care expenses of the entire family, even though only one family member has paid anything toward the aggregate deductible.

What Expenses Count Toward the Family Aggregate Deductible?

The only expenses your HDHP will count toward your aggregate deductible are expenses for covered health plan benefits.

For example, facelifts aren’t usually a covered health plan benefit. If you get a face lift, the money you pay for it won’t count toward your aggregate deductible.

Your health insurance company can’t credit any of your out-of-pocket medical expenses toward your deductible if it doesn’t know about them.

Make sure you or your doctor file claims for each of your medical expenses, even if you know you must pay them yourself because you haven’t met your deductible yet. This is how your health insurance company knows how much you’ve paid toward your deductible.

What Expenses Are Exempt From the Aggregate Deductible?

In the United States, the Affordable Care Act requires that health plans pay for preventive health care services without requiring any form of cost-sharing. This means that your health insurance will pay for things like your flu shot, your kids’ immunizations, and your yearly mammogram even if you haven’t paid your deductible yet.


The Department of Health & Human Services has tweeked the rules slightly for non-grandfathered health plans using an aggregate deductible. The added wrinkle is this: a health plan can't require any individual to pay a deductible that is higher than the federal limit for the out-of-pocket maximum for individual coverage, even if that person is covered under an aggregate family deductible.

For 2016, the out-of-pocket maximum for an individual is limited to $6,850.

An Example: Let's say the aggregate deductible for your 2016 family plan is $12,000. Once any individual family member has paid $6,850 toward the aggregate deductible amount, coverage for that particular individual must kick in without requiring further cost-sharing like copays or coinsurance. This person's coverage kicks in because he or she has now reached the legal out-of-pocket limit for an individual. However, coverage for the other members of your family still won't kick in until the family's entire aggregate deductible has been met.

This adjustment to the rules takes place as soon as your health insurance plan renews in 2016. Until then, your health plan will likely follow the older rules. The government raises the upper limit on out-of-pocket maximums slightly each year to account for inflation.


Final HHS Notice of Benefit and Payment Parameters for 2016 (80 FR 10823). 

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