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You Snooze, You Lose!

Aug 18, 2023
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Tips for maximizing your health insurance deductible before your policy's anniversary date.

Most people with health insurance are familiar with deductibles – a sometimes elusive goal that is often only met when it’s too late to take advantage of it as your policy's anniversary date fast approaches.

Knowing how to plan ahead to maximize your deductible can be challenging, so understanding how your plan works and what is covered is a crucial part of making the most of the money that you invest in your health insurance each year.

What is a Deductible and How Does it Work?

Let’s face it, health insurance is complicated!  Fortunately, many of the major medical insurance companies offer great concierge services and access to customer service representatives who can answer any question that you may have about your policy.  One of the key components that you will want to know about is your deductible deadline if your plan has one.

According to the latest data from the Kaiser Family Foundation, the average deductible for a single person in an employer health plan is $2,004. 

Here are some basic terms that you should know about your policy:

Health insurance deductible: Amount you pay out of your own pocket before your insurance begins contributing to medical costs. Deductibles apply to both services and medical devices.  Different providers may have separate requirements for individual and family plans.

Maximum deductible: Yearly set total you must pay out-of-pocket before your insurance plan starts picking up the cost of medical purchases.

Annual deductible reset: Each year your deductible will reset at the anniversary date that your policy began. That means your deductible goes back to zero and you are required to start paying out of pocket again for medical purchases.  Knowing when your plan resets can be beneficial for getting the most out of your premiums.

Copayment: Copayments (or copays) are a fixed dollar amount that you pay for a covered medical service, such as a doctor’s visit.

Coinsurance: Coinsurance is the percentage of the cost of covered medical services that you’re responsible for paying. You also pay coinsurance after you’ve met your deductible. For example, if you have a health plan with a $2,000 deductible and 20% coinsurance and your doctor charges $100 for an office visit, if you haven’t yet met your deductible, you’ll have to pay the entire $100 bill. However, if your reach your deductible, your health insurance will cover 80% of the cost ($80) and you will pay 20% ($20).

Keeping track of your spending against your annual deductible will help you to know when you are getting close to meeting your limit.  

Tips for Making the Most of Your Out-of-Pocket Costs. 

Visiting your Primary Care Physician early in the year will help with having a plan in place for benefiting from a low or no deductible amount.

Wellness appointments such as mammograms, colonoscopies, and screenings for diabetes, cholesterol, and blood pressure can sometimes result in additional lab work, visits to specialists, medications, or unplanned treatments that can be expensive.  The sooner your calendar year that you meet your deductible, the more money you can save as your policies reset date approaches.

At Pennsylvania Dental Sleep Medicine, we help our patients determine when they are ready to seek Oral Appliance Therapy treatment for obstructive sleep apnea by verifying eligibility, calculating unmet deductible amounts, and submitting pre-authorization if it is required.  Dr. Fox communicates directly with referring physicians, specialists, and insurance providers to ensure that any follow-up care and testing is coordinated in a timely manner.

According to the NPR article “6 Tips to Help You Get the Most Out of Your Health Insurance Plan”, if you have a big medical procedure that you can plan for, there are a couple of ways to approach scheduling it so that you're maximizing your health care coverage.

Some people will wait until they've met their deductible to get a big procedure, which could make sense if you don't have a lot of money saved up. If you pay into your deductible with health care services you get over the course of the year and then schedule surgery for after you've met it, it's more likely your insurance will pay the bulk of the surgery cost and you won't have to pay a big out-of-pocket bill.

Others who have the money upfront might choose to schedule a more expensive procedure to meet their deductible early in the year, with the peace of mind that the rest of their healthcare costs that year will be covered by insurance.


Whether you choose to treat your sleep apnea at the end of the 2023 calendar year to take advantage of low, or no, deductible or to get your oral appliance first thing in the 2024 new year, Pennsylvania Dental Sleep Medicine can quickly check your deductible balance and help guide you. 

Take these steps to prepare for your visit with us:

1. Schedule a face-to-face appointment with your PCP, cardiologist, pulmonologist, or sleep doctor. 

2. Ask your physician to order a sleep study to determine your level of apnea.  Most doctors can order a Home Sleep Test that will be mailed directly to your house.

3. Determine if your insurance requires a CPAP trial before, then ask your physician to write a prescription for a custom-fabricated, mandibular advancement oral appliance.

4. Contact our office to register for an initial consultation with one of our qualified sleep dentists.

Dentists who solely focus on sleep disorders, like Dr. Becky Fox, offer oral appliances as an excellent alternative to CPAP. These devices are worn in your mouth while you sleep and help keep your airway open. They are noninvasive and nonintrusive, offering a custom fit, are comfortable to wear, and are covered by most medical insurance plans.

Our main priority is to help you live better by providing an effective option for treating sleep apnea, but we also do our best to work with you to maximize your health insurance costs.  

Call us NOW if you want to get quality sleep before the year's end!  (717)294-0482.


Blog resource:  https://www.npr.org/2022/04/28/1095250662/health-insurance-benefits-explained