a little bit at a time? I know it has to be paid b4 insurance will kick in but is it expected to be paid in a lumo sum or what. I'm trying to select insurance with a decent premium but not too high of a deductible...can someone shed some light possibly with an example?

If your deductible is $500, you must get $500 worth of services before the insurance policy begins paying the typical 80 percent. You still get your $20 office visits and $20 drugs and those count towards the $500. In my case, I've major surgery early in the year that easily has met my deductible. So my 80 percent payment is in effect the rest of the year. Generally, you try to get a lower deductible but that, of course, means higher premiums. But when I was between jobs, I had a policy with low premiums but a $1,000 deductible because I only needed it for my major surgery. (Which I never had, thank goodness.)

The deductible is money paid by you. If your yearly deductible is $1000, you would pay 100% of all medical expenses until you have spent $1000, and then the insurance would start covering it. There is nothing 'tacked on' to a bill; that makes no sense at all.