Clinics and hospital operating rooms have recently become noticeably busier as people try to squeeze in appointments and procedures before the end of the calendar year. Many are taking advantage of lower cost-sharing after deductibles and out-of-pocket maximums are met. Others want to use up insurance benefits before their plan resets or changes. Indeed, now is a great time to review your health care needs, budget, and expenses.
Deadlines for health insurance applications
First off, make sure you have health insurance lined up for next year (See our previous articles on how to choose insurance plans here and here.). If you have Medicare, the last day to convert from traditional to Medicare Advantage (and vice versa), or to switch plans, is Dec. 7. If you need to sign up for Medicare, the general enrollment period runs from Jan. 1 to March 31. The last day to purchase a plan from the health care marketplace is Dec. 15 for coverage to start in January, or Jan. 15 for coverage that starts in February. Check with your human resources department about open enrollment for employer-sponsored plans.
Deductibles and out-of-pocket max
The deductible is the amount the patient must pay for medical services before their insurance kicks in. After you meet the deductible, insurance will cover the majority of the cost of care. The deductible resets at the beginning of every year, so if you delay care until then, you’ll need to meet that threshold again. If you haven’t met your deductible yet, some plans allow “fourth-quarter rollover” so the amount you pay in the last few months of the year is credited for the next year’s deductible, which is helpful if you’ve incurred large health expenses late in the year.
As the deductible and coinsurance accumulate, the total may reach your out-of-pocket maximum, after which insurance will pay 100% for covered services by in-network providers. You can essentially enjoy “free health care.” Check your insurance member portal to see if you’ve met the deductible and out-of-pocket amounts yet. Keep in mind these amounts may increase next year if you switch plans, so utilize your benefits and save money before the policies change.
Health flexible spending accounts
If you’ve set aside money into FSAs, for healthcare or dependent care, then you must spend the funds by the end of the year. These accounts are “use it or lose it,” although some may give you a grace period of a few months. Things eligible for health FSAs include the usual copays and coinsurance, but also eyeglasses, hearing aids, over-the-counter medications, and pharmacy purchases such as vitamins, condoms, sunscreen, and sanitary pads. Save the receipts and submit reimbursement by the deadline which is usually in the spring.
Medical services to consider
Whether you’re trying to spend down an FSA, meet your deductible threshold, or get the most out of your insurance benefits, here are some services that can improve your health (physical, mental and financial):
* Order a 90-day supply of your prescription medicine.
* See a specialist or obtain a second opinion.
* Complete preventive screenings. Common tests include mammogram, colonoscopy, calcium score for heart disease, bone density scan, and imaging for lung cancer and aortic aneurysm. What’s appropriate for you depends on your age and medical history, so check with your doctor.
* Schedule elective surgeries that can enhance your quality of life – cataracts, acid reflux, hernias, joint replacements, you get the idea. Less invasive procedures include joint and spine injections, acupuncture, and physical therapy.
* Get an eye exam. If you have vision insurance, use up the annual allowance for glasses or contact lenses.
* Dental insurance usually has a maximum benefit limit. If you haven’t used all of it, it’s time to take care of that root canal or chipped tooth. If you need significant dental work that will cost a lot, ask the dentist to split the work between now and January so you maximize both this and next year’s benefit.
Your to-do list might be already growing long as the holiday season approaches, but that’s no excuse to overlook your health. Give your body some well-deserved attention and you can start 2022 having already fulfilled some of those New Year’s resolutions!
Qing Yang and Kevin Parker are a married couple and live in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. She is an anesthesiologist at HSHS Medical Group. Parker has helped formulate and administer public policy at various city and state governments around the country. He is formerly the group chief information officer for education with the Illinois Department of Innovation and Technology. This column is not intended to substitute for professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the views of their employers.
This article originally appeared on State Journal-Register: Now is the time to review your health care needs and finances