Start Treatment Before Your Deductible Resets
If you’ve been thinking about getting help for addiction, the end of the year can raise a practical question: what happens to my insurance costs when my deductible resets? For many people with private insurance, the deductible and out-of-pocket maximum start over on January 1. If you’ve already paid a good share of your deductible this year, December may be when treatment costs you the least. Verify your insurance benefits to see where you stand, or keep reading to learn how to check for yourself.
One thing first: if you need help now, don’t wait for a date on the calendar. The best time to start treatment is when you’re ready.
How a Deductible Reset Affects Treatment Costs
Your deductible is the amount you pay for covered services before your plan starts sharing costs.¹ After that, you usually still pay copays or coinsurance until you reach your out-of-pocket maximum, which is the most you’ll pay for covered services in a plan year.¹ With most plans, your deductible counts toward the out-of-pocket maximum, and only covered, in-network services count toward the in-network limit.¹
Both numbers reset when a new plan year begins, and you start over.¹ On a calendar-year schedule, that is January 1. Other plans reset on the first day of the plan’s renewal month, which could be any month.² So your plan year may not match the calendar year, and you’ll need to look up your own reset date.
Coverage matters, too. Marketplace plans must cover substance use disorder treatment as an essential health benefit, though the specifics depend on your state and plan.³ If your insurance comes through an employer or another source, your benefits may differ, so it’s worth confirming what your plan covers. American Addiction Centers is in-network with many private insurance companies, and our team can verify your benefits for you.
Check Where You Stand Before You Decide
A few questions can show whether timing matters for you. Your insurer’s member portal, your plan documents, or a call to the number on your insurance card can answer all of them:
- When does your plan year end? Find out whether it’s December 31 or another date.
- How much of your deductible have you met this year? Your most recent explanation of benefits or member portal shows your progress.
- How close are you to your out-of-pocket maximum? It’s the most you’ll pay for covered, in-network services this plan year.
- Is the program in your network, and what level of care does your plan cover? In-network and out-of-network costs can differ a lot.
- How would a stay that crosses January 1 be billed? Ask whether costs after the reset count toward the new year’s deductible.
Want help finding these answers? Our team can check for you:
When Starting Before the Reset Can Help, and When It May Not
Timing helps some people and not others. Use the table as a guide, then confirm the details with your insurer or our admissions team. For a broader look at pricing, see how much rehab costs.
A deadline can be a useful nudge to make the call, but it shouldn’t decide whether you get help.
Don’t Wait for a Date
If you or a loved one is struggling now, the best time to start is right away. Long waits for treatment have been linked to lower functioning, more involvement with the criminal justice system, and less motivation to get help.⁴ Obstacles like work or school schedules, family obligations, and limited finances can keep people from entering treatment. A call can help you sort out which obstacles you can work around.
Why the Holidays Can Be a Good Time to Start Treatment
Beyond your plan year, there are good reasons to start treatment during the holiday season:
- Time away is easier to arrange. Many employers already provide time off at the end of the year, which may make it easier to fit treatment into your schedule.
- Support in a hard season. The holidays aren’t filled with unicorns and rainbows for everyone. They can bring loneliness, regret, shame, and addiction-related conflict that strains family relationships. Treatment can offer the support you need to experience the holidays with more hope.
- A safe haven from triggers. A treatment facility can give you a break from the pressures, temptations, and triggers in your hometown environment.
- Peace of mind for your family. Families often spend countless hours worrying about a loved one. Entering treatment can give them the comfort of knowing you’re safe and getting help.
- Presence, not just attendance. While you’re using, it’s difficult to be genuinely engaged with the people around you. Recovery is an investment in more meaningful future memories.
- A fresh start and new connections. Connecting with peers and addiction professionals now can set you up for success in the new year and beyond.
- More holidays to celebrate. Treatment can save lives, especially given the risk of accidental overdose and the toll addiction can take on physical and mental health.
Treatment Options at American Addiction Centers
With facilities across the country, AAC offers levels of care to match your individual needs, including inpatient and outpatient programs, detox, and telehealth services.
Get Started Before the Year Ends
Our caring and confidential admissions navigators can answer your questions, explain your treatment options, and verify your insurance benefits so you know what to expect. Contact one of them at .
If you prefer texting to calling, we understand. Even if you’re not yet ready to talk to someone, you can receive text support 24/7.
