Does home insurance pay 100% after the deductible?
Short answer. Home insurance pays the covered amount of the loss after the deductible, up to your limits, but that is not always 100 percent of what the job costs. Depreciation on actual cash value policies, roof payment schedules, coverage limits, code upgrades without ordinance or law coverage, and items the adjuster missed can all leave a gap.
Not like health insurance
Health plans often switch to 100 percent coverage after you hit a deductible and out of pocket maximum. Home insurance works per claim: the insurer pays the covered loss, calculated under your policy's settlement terms, minus the deductible. There is no separate coinsurance percentage on the payment itself.
A worked example
Say a hail claim is approved at a replacement cost of $18,000, depreciation is $6,000 and the deductible is $1,500.
- Replacement cost policy: first check $10,500 (actual cash value minus deductible), then $6,000 more after the work is done and invoiced. Total $16,500, the full cost minus the deductible.
- Actual cash value policy: $10,500 and nothing more. You fund the remaining $6,000 plus the deductible.
Other things that cut the payout
- Roof payment schedules that pay a percentage based on the roof's age.
- Underinsurance: many policies reduce replacement cost payments if the home is insured for less than a set share, often 80 percent, of its replacement cost.
- Code items like new drip edge or ice barrier, paid only if you have ordinance or law coverage.
- Missed items like vents, flashing or decking, which need a supplement.
See ACV versus RCV, roof payment schedules and code upgrade coverage.