Your Deductible Resets on January 1. 8 Things to Check Before It Does

Key points

On most plans, the deductible and the out-of-pocket maximum start again from zero when a new plan year begins, usually January 1.
If you have already met your deductible this year, care you need anyway may cost you less now than it will in January.
Several deadlines fall in the same weeks: FSA spending, plan enrollment, appeals and claims you have not filed yet.

In October, Renee finished paying off her deductible. It had taken a sprained wrist in March, a round of physical therapy and one long afternoon in an imaging center to get there. For the first time all year, her plan was paying most of the cost of her care.

Her doctor had mentioned a follow-up scan and a referral to a specialist. Neither was urgent, so Renee booked both for the second week of January, when work would be quieter. She did not think about what else would change by then.

On January 1, her plan’s counters went back to zero. The scan that would have cost her a 20 percent share in December was billed at the full negotiated price in January, because she was once again at the start of her deductible. Nothing about her health or her plan had changed. Only the date had.

Renee is invented for this article, and so are the details. The reset she ran into is real, and it happens to almost everyone with a deductible.

What you paid toward your deductible this year does not follow you into next year. On most plans, the count simply starts over.

What actually resets

Health plans run on a plan year. For most individual plans and many employer plans, that is the calendar year. Some employer plans use a different twelve months, such as July to June, so check your plan documents or your insurer’s member portal before you rely on any date in this article.

Usually starts over

Your deductible.
Your out-of-pocket maximum.
Yearly visit limits, such as a set number of therapy sessions.
Your health FSA balance, unless your plan has a carryover or grace period.

Usually carries on

Money in a health savings account (HSA).
Bills you still owe from this year.
Your right to appeal a claim denied this year, within the plan’s deadline.

The out-of-pocket maximum is the bigger of the two numbers and the one people watch least. Our guide to the number in your plan that can cap your bills explains how it works.

Eight things to check before the year ends

Find out where you stand

Log in to your insurer’s portal and look for your year-to-date deductible and out-of-pocket totals. If a recent claim is missing, it may still be processing. Everything else on this list depends on these two numbers.

If you have met your deductible, look at care you already need

A follow-up visit, a scan your doctor has ordered, physical therapy, a medical device or a planned procedure will generally cost you less while your plan is paying its larger share. Ask the office whether it can be scheduled this year. This is about timing care you need anyway, not adding care you do not need.

If you are nowhere near it, do not delay care because of the calendar

When you have paid little toward your deductible, December and January may cost you about the same. Let your doctor’s advice decide the timing. Never postpone something urgent to line it up with a plan year.

Ask about prescription refills

If a refill is due in the last weeks of the year, filling it before the reset can mean a lower price. Plans limit how early a refill can be filled, so ask the pharmacist what your plan allows. If your plan or its drug list is changing in January, ask now whether your medicine will still be covered.

Check your FSA balance and its deadline

Money left in a health flexible spending account is generally forfeited at the end of the plan year unless your employer’s plan offers a carryover or a grace period. Our FSA guide explains the three rules that decide it. An HSA is different: the money stays yours, and contributions for a tax year can generally be made until the tax filing deadline the following spring.

Confirm next year’s plan before the enrollment window closes

Employer enrollment windows are often short and end well before December. For HealthCare.gov plans, you generally need to enroll by December 15 for coverage that starts January 1, and some state marketplaces use different dates. See the dates that decide when marketplace coverage begins. If you have Medicare, the fall enrollment period ends December 7, as covered in our Medicare guide.

If you are switching plans, protect care that is in progress

A new plan can mean a new network, a new drug list and new approval rules. An approval your old plan gave for a treatment does not automatically transfer. Call the new plan before January and ask what it needs. These six things may not follow you when you change insurance.

Close out this year’s paperwork

Look for claims still marked pending, bills that do not match their explanation of benefits, and denials you meant to appeal. Appeal deadlines run from the date of the denial, not from the end of the year, so check the date on the letter. Keep this year’s statements together in case a claim is reprocessed later.

The same visit, two different months

Here is how the reset changed Renee’s bill. The numbers are hypothetical and assume a $2,000 deductible, 20 percent coinsurance and a scan with a negotiated price of $900.

December

January

Deductible already paid

$2,000 of $2,000

$0 of $2,000

Negotiated price of the scan

$900

What she pays

$180

$900

Hypothetical example. Actual plans vary.

In December, she owes 20 percent of $900, which is $180. In January, the full $900 goes toward a deductible she has not started paying yet. The $900 is not wasted, because it counts toward the new year’s deductible. It is simply $720 more out of her pocket for the same scan.

Three cautions

The date of service is what counts. A claim is generally assigned to the plan year in which the care was given, not the year the bill arrives or is paid.

December schedules fill up. Many people have the same idea. If you want an appointment before the reset, call early, and ask to be put on a cancellation list.

Approval still matters. If a service needs prior authorization, it needs it in December too. Confirm the approval before the appointment, not after.

Questions people ask

Does every plan reset on January 1?

No. Most individual plans and Medicare follow the calendar year, but some employer plans use a different plan year. Your plan documents and your insurer’s portal show the dates that apply to you.

If I change jobs or plans mid-year, does my deductible start over?

Usually yes. A new plan generally starts its own count. Some employers arrange credit for what you already paid when they switch insurers, so it is worth asking.

Does Medicare reset too?

Yes. The Part B deductible and Part D drug costs are counted by calendar year, and the amounts are updated each year. Medicare.gov lists the current figures.

Should I ask for extra tests just because my deductible is met?

No. You still pay a share of most care after the deductible, and tests you do not need can lead to more tests. Use the timing for care your doctor has already recommended.

Renee keeps a note on her phone now. Each October she checks two numbers in her insurer’s portal, and if the deductible is met, she asks her doctor one question: is there anything we were planning to do anyway that could happen before the end of the year?

Official sources: HealthCare.gov, Out-of-pocket maximum; HealthCare.gov, Renew, change or update your plan; HealthCare.gov, How to appeal an insurance company decision; IRS Publication 969, HSAs and other tax-favored health plans; Medicare.gov; your plan documents.

This article is educational information, not legal, medical, tax or financial advice. Names and dollar amounts are hypothetical. Plan years, deadlines and rules differ by plan and can change, so confirm the details with your plan and with official sources. Never delay care your doctor considers urgent.