Staying smart about end-of-year healthcare


November is one of the most important months for health benefits. And it’s now more than half over.

This month is a time of open enrollment, when many workers sign up for next year’s health insurance. Deadlines are a big deal, and you don’t want to miss one.

But once you’re set for 2013, experts say, shift your attention back to 2012 and those use-’em-or-lose-’em benefits awaiting you.


“Anything employees can do to accelerate elective care at year end allows them to get the full benefit” of their health plans, says Mike Thompson of consulting firm PricewaterhouseCoopers.

Here is a look at ways experts recommend to avoid leaving money on the table.

Make the most of your deductibles. Deductibles — the money you’re required to pay out of pocket before insurance covers all or part of your healthcare services — are becoming more prevalent and more expensive.

If you’ve met your annual deductible for 2012, now may be a good time to schedule any medical treatment you’ve been delaying.

“At the beginning of the calendar year, everything resets with new out-of-pocket limits and deductibles. It’s better to get any discretionary services done by the end of the year so you’re in benefit and can get expenses reimbursed,” Thompson says.

Today, a person with single coverage pays $1,097 on average in medical bills before insurance kicks in. According to Menlo Park, Calif.-based Kaiser Family Foundation, 72% of workers enrolled in an employer plan are on the hook for a deductible, up from about half in 2006. The amount of deductibles has also risen 88% during the same period.

And don’t forget the possible savings of ordering prescription drugs before year end. You may be able to order a 90-day supply now to get you through the first few months of the year.


“It may make sense to accelerate your purchases of prescription drugs toward the end of the year because you know you’re going to need them and they won’t be subject to the deductible,” Thompson says.

Be careful with your calculations. It should be easy to determine whether you’ve met your deductible for the year. But it can get tricky when you consider a lag, sometimes months long, between the time your doctor submits a claim and your insurance company processes it. You and your insurer may not have the same tally with regard to how much you’ve spent during this benefit year.

“My recommendation is to work with your broker’s office to get an accurate assessment as to where you are in your benefit,” says Dave Morgan, senior employee benefits advisor with Morris and Garritano Insurance Services in San Luis Obispo.

If you get health insurance at work, talk with your benefits or human resources department for assistance.

Coordinate your care. There’s a caveat to the recommendation that you squeeze in care before New Year’s Day. Consider first, Morgan says, the “choreography” of your care and how that may affect costs.

For example, knee surgery is likely to require months of follow-up physical therapy. Would it be less expensive to have your surgery fully covered in 2012 and pay cash for your physical therapy starting in 2013 before your deductible is met? Or, might holding off on the surgery until early 2013 result in less cash out of your pocket given the overall course of treatment?


To reap the greatest benefit from your health plan, do the math on both scenarios.

Splitting care between one year and the next can make sense, especially for dentistry. Dental plans typically come with an annual maximum benefit of $1,000 to $1,500. If you’re in need of an expensive procedure, it may make financial sense to get started in December and finish in January.

“There’s no perfect way to navigate all of this,” says Martin Rosen, executive vice president of Health Advocate, a patient advocacy organization based in Pennsylvania. The key, Rosen says, is to “understand how your particular plan works and the leverage points throughout the year for which timing does make a difference.”

Use your annual benefits. Be sure to take advantage of benefits with calendar limits, such as semi-annual dental cleanings, free eyeglasses or contact lenses. The same goes for preventive health services.

“When you get that preventive care, you’re going to have a sense of what issues you’ll face with your health in the coming year,” Morgan says. That may better inform your 2013 health benefit choices as well as how much money to set aside in a Flexible Spending Account, or FSA, for next year.

Use all your FSA money. Unlike Health Savings Accounts, or HSAs, which allow you to roll over pretax dollar savings from one year to the next, FSAs have a shelf life. Typically you need to fully spend the account by year’s end or you’ll lose the money left over.

On average, people forfeit about $120 each year, says Jody Dietel, chief compliance officer at San Mateo, Calif.-based WageWorks, which administers employer-based tax advantaged accounts.


The IRS allows a grace period of 2 1/2 months, or by mid-March of the following year, to spend FSA money. And, according to Dietel, 75% of her company’s 22,000 employer clients offer employees a grace period. But the length of time varies widely among employers, so check with your plan administrator to learn what’s allowed.

Also, keep in mind that some rules have recently changed because of health reform. “For example, with an FSA you can’t get over-the-counter drugs without a prescription from the doctor,” Rosen says. To see a list of eligible expenses, go to the FSA Store at and click on the eligibility list at the bottom of the home page.

Many people lose money simply by failing to claim the expenses they already have, Dietel says. “Go and see if there is unfound money someplace,” she says.

For example, if you fill all your prescriptions at the same pharmacy, ask the pharmacist to print a list of the co-pays for this year, and submit any outstanding charges to your Flexible Spending Account.

One final piece of advice before you pick up the phone to schedule your end-of-year doctor visit: Follow your health plan’s rules, Morgan says. Stay in your health plan’s network of doctors and hospital, and “make sure you have the proper pre-authorization in place.”