Key takeaways
- Whether your prescription medication costs count toward your deductible depends on your plan, but many plans do count these costs. These costs generally count toward your out-of-pocket maximum as well.
- How much your deductible is depends on your individual insurance plan, and some plans have separate deductibles for medication costs and other medical expenses.
- If you’re not sure about your deductible and what your plan covers, you can look at your insurance documents or contact your provider.
Many health insurance plans have a deductible, which is the money you must pay out of pocket for medical costs before your plan starts covering them.
Some plans allow all medical expenses to meet deductibles, while others might have separate deductibles for prescription medication costs and other medical costs, such as lab tests or hospital stays.
In most cases, medication costs count toward your deductible, as long as your specific plan covers the drugs.
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The deductible on your health insurance is the money you must pay for medical costs before your insurance covers them. This deductible usually resets yearly.
Your plan may have one deductible for all medical expenses, including medications and other costs, such as hospital stays. In that case, you must pay for your prescriptions if you still need to reach the deductible for that plan year.
For example, if your deductible is $100, you must pay for your medical costs until you spend $100. After that, your insurance may cover some or all of the costs. If your health insurance has a medications-only deductible, you must pay for your medications in full until you reach the deductible amount.
The value of your deductible depends on your insurance provider and your specific plan. When signing up for a plan, you can customize your deductible amount. A plan with a lower deductible may have a higher monthly premium.
You can add a Medicare Part D extension to your plan if you have regular health insurance. Medicare Part D plans exclusively cover prescription drug costs. Medicare deductibles cannot be higher than $590.
Your out-of-pocket maximum is another figure that you may see in your health insurance plan — and this is different from your deductible, but it has a similar principle.
Once you meet your deductible, you may still need to pay other healthcare costs, such as copayments or coinsurance for medical services. Your out-of-pocket maximum is the most you must pay for covered services in a plan year, which aims to protect you from extremely high healthcare costs.
Prescription costs, among other medical services, do contribute to out-of-pocket maximums. However, some charges don’t count toward this. These include:
- your monthly premiums
- appointments with medical professionals outside of your plan’s network
- medications or services that your plan doesn’t cover
In 2026, the highest out-of-pocket maximum for a health insurance plan will be $10,600 for an individual and $21,200 for a family. However, your individual insurance plan may have a lower limit.
The costs that count toward a deductible depend on what your specific plan covers. When deciding on a plan, you may review what the deductible covers and decide based on what’s best for your needs.
Some expenses that may count toward a deductible and that insurance may cover include:
- prescription medications
- lab tests
- X-rays
- hospital visits
- medical procedures
Some costs that generally don’t contribute to your deductible include:
- monthly premiums for your insurance
- doctor’s appointment copays
- travel costs to visit a doctor in person
In general, health insurance plans have a combined deductible for all medical expenses or one deductible for general expenses and a different one for prescription medications. You must pay the full cost of your prescriptions until you meet your deductible, whichever kind you have.
Prescriptions usually count toward the deductible as long as your plan covers them. Depending on your plan, your copay for a prescription may also count toward the deductible. Prescriptions also tend to count toward your out-of-pocket maximum.
A health insurance agent can help you determine what type of deductible you have and which prescriptions your plan might cover.