How To Make The Most Of Your Health Insurance When You've Finally Met Your Deductible

produced by Lorenna Gomez-Sanchez; photographed by Martin Mendizabel.
The Thanksgiving leftovers have been eaten, and Black Friday sales are winding down. It's time to turn our attention to equally pressing but less fun concerns — like all the end-of-year medical questions we need to resolve. When does open enrollment end? Are your dependents up to date? And did you meet that unreasonable deductible yet? That last question is important this time of year, because deductibles reset in January. And if the answer is yes, it's time to schedule some not-so-urgent medical appointments.
A deductible is the dollar amount you have to pay out of pocket for healthcare before your health insurance plan begins paying for services, a spokesperson for Oscar health insurance told Refinery29. When you "meet your deductible," it means that you've paid your share, and — jackpot — any additional medical services you need this year should be covered by your insurer. (If your plan has an out of pocket maximum, you may still have copay or co-insurance fees once the deductible is met, so check the details before going on a doctors'-appointment spree.)
So, what kind of appointments should you make if you have met your deductible? In general, it makes sense to schedule elective procedures and preventative appointments, so you can get them out of the way before you have to start paying again. For example, depending on your plan, now may be a good time to see a dermatologist to have any concerning moles checked out, or a physical therapist to ask about a weird injury you've been dealing with. A trip to the ophthalmologist to have your eyes examined might save you a hefty bill next year (because ophthalmologists are medical doctors, their care falls under your medical plan — not your vision plan).
Any diagnostic tests that you've been putting off, such as an allergy test or blood work may be worthwhile, too. And if you're really trying to be proactive, consider a colonoscopy if you've struggled with gastrointestinal issues this year and think you may want a doctor to take a closer look. Since some insurance plans will only cover mental health services once you've met part of your deductible, this could be a great time to reconnect with your therapist and get a few between-holidays appointments on her books. Then, dig into your coverage handbook to see how your plan covers things like chiropractic care and acupuncture. You may be in for some very rejuvenating self-care before the new year.
Whether or not you meet your deductible is entirely based on your health profile, according to Oscar. Some people have low deductibles and are managing chronic illnesses, so they meet their deductible quicker than those who, say, have high deductibles and pay as they go for health care. If you have met your deductible for the calendar year, then it's important to make sure you submit any further claims to your insurance company correctly, so you can get properly reimbursed for your expenses.
If you haven't met your deductible, that just means you've probably had a pretty healthy year with limited medical expenses, explains a spokesperson for Oscar. And if that's the case, it doesn't make sense to try to spend it all before the new year. At this point, it would be more beneficial to schedule appointments for the new year, so you can put all that money toward your refreshed deductible, and have a better chance of getting all these add-on appointments paid for this time next year.
If you're not sure where you stand with your deductible, just ask a representative from your health insurance company — that's what they're there for. Otherwise, take advantage of the lull between holidays to get a head start on your health for the new year.
Ed. note: We have added a correction to clarify the meaning of "out of pocket maximum."

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