Expert tips for preparing for a new health plan year

Whether moving to a new health plan in 2025 or beginning a new plan year on the same one, a review of coverage may be warranted, according to experts. Shawn Stack, a policy director at the Healthcare Financial Management Association, shared the following advice.

Understand your medical coverage

It’s important for patients to know what services and medications are covered under their health plan, and whether those things have changed in the new plan year, Stack said. Although many health plans begin a new year with the calendar year, some do not, so patients should be sure when their plan year is starting. Patients also should check if their premiums, deductibles, copays and out-of-pocket maximum amounts have changed.

In-network physicians and hospitals may go out-of-network in a new plan year, Stack said.

“If they’re [no longer in network], reach out and find out who is in network ... so you’re seeking care in network to minimize your cost.”

Schedule smart

If a patient has met their out-of-pocket maximum for 2024, it’s a good idea to try to squeeze in needed care before the year is over, Stack said. On the other hand, if a patient has not met that amount, or their 2025 health plan has better coverage, it could be a good idea to wait until the new year to minimize expenses.

“Talk to your physician and make sure delaying care is not detrimental to your health,” he said. “Keep in mind that most health plans reset deductibles, copays and out-of-pocket maximums with the beginning of the new benefit year.”