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Make the Most of Your Health Insurance Before the End of the Year


The start of a new calendar year sends many people into reset mode. They’re resetting their goals, resolutions and frames of mind at the start of each year. A lot of people tend to forget that their health insurance plan is getting ready to do the same thing with a new year reset of its own. A new year means new deductibles, new out-of-pocket maximum payment responsibilities and new Flexible Spending Accounts (FSA) for people who use them.

What Are Deductibles and Out-of-Pocket Maximums

A deductible is the amount of medical expenses you are responsible for paying before your insurance company steps in to cover any portion of medical costs. At the start of each year, your deductible resets to zero. That means that before your plan will pay for services in the new year, you’ll have to meet your deductible once again.

Your out-of-pocket maximum is the amount you may have to pay after you meet your deductible, depending on your health plan. For example, some health plans pay only 80 percent of the cost of your care after you meet your deductible but before reach your out-of-pocket maximum.

End of Year Brings Opportunity to Save

“The last few months of the year are a great opportunity to schedule any procedures you’ve been putting off if you’ve reached, or are close to reaching, your deductible,” says Amy McCartan, Senior Director, Managed Care Contracting at Crozer Health. “If you wait for the beginning of the year, you’ll be on the hook to pay for procedures that would have been covered if you got them done a few weeks or months earlier.”

You pay for your coverage, so why not make the most of it. Common elective procedures, meaning care that is planned and not done in an emergency situation, can include:

Some elective procedures, such as cosmetic surgery that is not done for medical reasons, may not be covered so be sure to check with your insurance plan.

On the other hand, if you are not close to meeting your deductible it may make sense to put off any expensive procedures that are not time sensitive until the new calendar year begins. That way you’ll be paying a lot into your deductible early in the year, which means you’ll be covered for any health care costs in the second half of the year.

“If you’re squeezing in a last-minute procedure for the year, be mindful that there may be secondary procedures, follow-up care or physical therapy that won’t be covered if they come months later when your deductible has reset,” says McCartan. “It takes some planning and thinking ahead to take a look at your overall health and do your best to map out what, if any, care you’ll need in the near future.”

If you have a Flexible Spending Account (FSA) through your employer, those benefits are also “use ’em or lose ’em.” Unlike Health Savings Accounts (HSAs), any pre-tax dollars set aside from your paychecks to cover eligible health care expenses in an FSA do not get rolled over to the next year. Some plans may offer a grace period in the first few months of the year, but most consider that money forfeited if the clock runs out.

Consider Vacations and Time Off From Work

“We see quite a significant increase in elective care procedures at the end of the year not only due to people making the most of their benefits, but also because a lot of people like to plan surgeries around the holidays,” says McCartan. “Work tends to be more flexible and forgiving with any time off needed, or their employers may be closed entirely so they can hang on to their PTO days.”

If you’re unsure what your deductible is or the nuances of your plan when it comes to “in-network” requirements, call your insurance provider to check before planning any appointments.

You can get more information about financial obligations you may have for elective surgery on the Patient Financial Resources section of the Crozer Health website.

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