What does the new year mean for my insurance coverage?

propose the question of what a new year means for rehab insurance coverage

Wednesday, December 30, 2020 | By Alexander Ronzino

Does your deductible reset? What does it all mean and how much could you be responsible for?

So long 2020, you won’t be missed!

It’s been a trying start to the 20’s. The beginning of 2021 brings hope for a COVID Vaccine. This is the start of the return to normalcy and safety. 

As we enter January, it’s also a time when many individuals are faced with questions about their insurance coverage. What happens with the new year starting? This article is to help guide you through many of the frequently asked questions regarding insurances resetting in the new year.

What impact does the new year have on my insurance coverage?

A new year can mean a lot of things for your insurance coverage. It can mean a new plan all together if you’re switching carriers. It can also mean your deductible / out of pocket resetting

Even more, it can mean additional costs if you’re already in treatment.

Do you know your insurance carrier and your plan is not changing? Then the first thing to find out is if your insurance plan benefits reset on Jan 1.

When does your health insurance deductible reset?

Well, that depends. 

Insurance coverages typically run by either a “Plan Year” or a “Calendar Year”.

“Plan Year”: coverage is when coverage dates are anything other than Jan 1 – Dec 31st. 

These insurance policies are less common. It is suggested to call your insurance provider to find out what your coverage dates are.

“Calendar Year”: insurance is the most common type of insurance plan which typically runs from January 1st to December 31st.

Keep reading below for what that means for you and what that could mean for out of pocket expenses.

Does my deductible and out of pocket reset in January?

If you’re on a calendar year plan, your deductible and out-of-pocket will likely reset on January 1st. Of course, it’s important to always check with your insurance provider to confirm.

Do health insurance deductibles reset every year?

Most do – either following the calendar year or the plan year.

How does that affect my treatment options in the new year?

If you’re currently looking for treatment and your deductible and out-of-pocket have reset, then one thing to take into consideration is whether or not the facility you’re looking at is in-network or out-of-network. 

In-network facilities count against your in-network deductible and out-of-pocket which is typically much lower than your out-of-network coverage. That means you can save thousands of dollars by attending an in-network drug rehab program and it’s important to take that into consideration when considering a facility.

If I’m already in treatment, how does the new year affect my insurance coverage?

If you’re already in treatment it’s important to find out what your upcoming deductible and out-of-pocket will be. You can find this out by contacting your insurance company or speaking with a staff member of the facility you are in. Be sure to have a clear answer on your in-network costs vs your out-of-network costs.

If you’re currently at an in-network facility, like Coalition Recovery in Tampa is for many insurances, you’ll likely have a lower deductible (or $0 in many cases). This means you’ll be responsible for whatever your deductible is as well as responsible for a co-insurance of the daily in-network rate. 

The daily in-network rate is a contracted rate between the treatment center and your insurance company and is almost always lower than out-of-network rates.

If you are at an out-of-network facility, you can potentially be responsible for higher deductible costs as well as out-of-pocket costs. It’s important to not only know your deductible and out-of-pocket amounts but also have a clear understanding of a provider’s fee schedule and balance billing policy so you can accurately project your cost burden. 
If you are at a state-funded facility, then neither of the above scenarios likely come into consideration. To learn more about the differences between state funded and private treatment centers you can click here.

Is Coalition Recovery in-network with any insurance companies?

Coalition is proud to be in network with the following insurances:

Is there anyone who can help me better understand treatment costs in the new year?

Any facility you enter should be able to provide you with a verification of your benefits where they clearly outline what your expected costs of treatment will be. You can always verify with your insurance company as well. Costs should never be unexpected and many providers do their very best to ensure clear communication so that you can focus on your treatment without having unnecessary concern about unexpected costs. This is vital to ensure you’re most prepared to enter and thrive in treatment.

At Coalition Recovery in Tampa, Fl, we’re proud to help you begin or continue your recovery in the new year. We offer many programs and are confident we have one that will meet your needs and lifestyle. Should you have any questions regarding what your expected treatment costs may be, please feel free to contact us using this form or call us at 888-707-2873.

Should you have any questions regarding the COVID-19 protocols we have in place, be sure to check out our COVID article here.

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