How to Make the Most of Your Health Insurance Benefits Before Year-End
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As cold and flu season approaches and the plan year winds down, it’s a good time to take another look at your health insurance benefits. Reviewing your coverage now can help you make use of the benefits you may have overlooked during the year.
Key Takeaways
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Use preventive benefits: Many plans cover annual wellness visits, screenings, vaccines, and other preventive care at little or no out-of-pocket cost when requirements are met.
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Check benefits before they reset: Review any unused benefits before the end of your plan year so you have time to schedule eligible care.
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Review your year-to-date costs: Knowing where you stand with your deductible and out-of-pocket maximum can help you plan upcoming care.
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Look ahead to next year: Consider whether your current coverage still fits your health care needs and budget before open enrollment.
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Compare your options: Coverage Fox’s licensed agents can help you review marketplace plans and explore coverage options for 2027.
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Annual wellness visits
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Recommended health screenings
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Flu, COVID-19, and other recommended vaccines
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Age-appropriate cancer screenings
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Sleep: If ongoing sleep problems are affecting your health, consider discussing them with your doctor.
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Diet: Some plans may cover nutritional counseling or other programs that support healthy eating.
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Exercise: Regular physical activity supports overall health, and your doctor can help you determine an appropriate routine.
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Stress: Behavioral health benefits may include counseling or other mental health services.
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Everyday prevention: Regular handwashing and other basic precautions can help reduce the spread of illness.
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Check your current benefits: Review your plan documents and see where you stand with your deductible and out-of-pocket maximum.
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Schedule care you may still need: Check whether you are due for preventive visits, recommended screenings, or vaccines covered by your plan.
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Review your prescriptions: Confirm that medications you take regularly will still be covered next year and check whether your costs are changing.
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Compare plans for next year: During open enrollment, review your options and consider whether your current plan still fits your needs and budget.
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Know when you can make changes outside open enrollment: Certain life events may allow you to enroll or switch plans at another time.
Why Year-End Is the Best Time to Maximize Your Health Insurance Benefits
For many health plans, deductibles, out-of-pocket maximums, and certain benefits reset when a new plan year begins. That makes the final months of the year a good time to review what you have already paid toward your deductible, and which covered services you may still want to use.
If you have already met much of your deductible or out-of-pocket maximum, some covered care may cost you less before the plan resets. The Affordable Care Act also requires many health plans to cover certain preventive services without cost sharing when requirements are met, so it is worth checking whether you are due for recommended preventive care.
Before the year ends, review your current benefits, check any remaining costs or limits, and schedule eligible care while there is still time. If you are considering a different plan for next year, Coverage Fox can help you compare marketplace health plans.
Understand Your Current Health Insurance Plan Before December 31
Before scheduling any year-end care, log into your insurance company or ACA marketplace account and download your 2026 Summary of Benefits and Coverage (SBC).
Key features to check in your current plan:
| Feature | What It Means |
|---|---|
| Monthly premium | The amount paid to keep insurance active |
| Deductible | What you pay out of pocket before the plan pays its share |
| Copayment | A fixed fee paid for specific services once the deductible is met |
| Coinsurance | A percentage of costs shared after the deductible is met |
| Out-of-pocket maximum | The cap on your annual spending (2026 ACA max: $10,600 individual, $21,200 families) |
Do not look at your monthly premium alone when reviewing your plan. Check how much you have already paid toward your deductible and out-of-pocket maximum, along with any copays or coinsurance that may apply to care you are considering before the end of the year.
Also confirm that the providers and services you plan to use are covered by your current plan. Reviewing these details now can help you understand what year-end care may cost and avoid unexpected expenses.
Use Preventive Care Benefits Now to Support Your Immune Health
Many ACA marketplace plans cover recommended preventive services at no additional cost when you meet the plan’s requirements, such as using an in-network provider. If you are due for preventive care, check your benefits and consider scheduling it before the end of your plan year.
Preventive services may include:
Check your plan before scheduling care to confirm what is covered and whether network requirements apply. Coverage Fox can help you review benefits available through an ACA marketplace plan and determine whether you may qualify for financial help with your health insurance costs.
Healthy Daily Habits You Can Pair with Covered Preventive Services
Healthy habits can support your overall well-being throughout the year. Your health plan may also include services that can help, such as nutritional counseling, behavioral health care, preventive visits, or telehealth.
Check your plan to see which services are covered and what costs or network requirements may apply.
Plan Ahead for Cold & Flu Season with Covered Visits, Medications, and Telehealth
Before cold and flu season picks up, take a few minutes to review how your health plan handles common care needs. Knowing where to go and what your plan covers can make it easier to get care without scrambling when someone gets sick.
Start by identifying an in-network primary care provider, urgent care option, and any telehealth or nurse-line services available through your plan. It can also help to review your prescription drug coverage, so you know where to find covered medications and what costs may apply.
If you are comparing coverage for next year, Coverage Fox can help you compare health plans based on features such as virtual care, urgent care, and prescription benefits.
Use the ACA Marketplace and Open Enrollment to Upgrade Your 2027 Coverage
Open enrollment is your opportunity to review your health insurance options for the coming year and decide whether your current plan still fits your needs. During this period, you can compare marketplace plans, update household information, and see whether you may qualify for financial assistance.
When comparing plans, look beyond the monthly premium. Review deductibles, provider networks, prescription coverage, and other benefits that matter to you. Think about how your current plan worked this year, including whether your doctors were in-network and whether your out-of-pocket costs were manageable.
Coverage Fox’s licensed agents can help you navigate the ACA marketplace, compare available plans, and explore coverage options for 2027.
Year-End Checklist: Concrete Steps to Take with Your Health Plan
Use this checklist to review your current benefits and prepare for the year ahead:
A year-end review can help you make use of your current benefits while making sure your coverage still works for you in the coming year.
Frequently Asked Questions About Year-End Health Insurance Benefits
Do unused health insurance benefits roll over to the next year?
In most cases, no. Deductibles and out-of-pocket maximums reset on January 1 for calendar-year plans, meaning the progress you made in 2026 does not carry over. However, health savings accounts (HSAs) do roll over unused funds, and certain flexible spending accounts (FSAs) may offer a grace period or small carryover amount. Check the details of your specific account to avoid losing money.
What if I miss ACA open enrollment? Can I still change my health insurance plan?
If you miss open enrollment, you may still be able to enroll in or change a marketplace plan if you qualify for a special enrollment period. Certain life events, such as losing other health coverage, getting married, having a baby, or moving, may qualify you for one. Enrollment deadlines vary, so check your eligibility and timing if your circumstances change.
Are flu shots and COVID-19 vaccines free with my health plan?
Many ACA-compliant health plans cover recommended flu and COVID-19 vaccines at no additional cost when you meet the plan’s requirements, such as using an in-network provider. Coverage can vary, so check with your insurer before your appointment to confirm any costs or network requirements.
Can Coverage Fox help me if I’ve never used the health insurance marketplace before?
Yes. Coverage Fox’s licensed agents specialize in guiding first-time enrollees through the entire process, from estimating income for premium tax credit eligibility to comparing plan tiers. You can visit Coverage Fox’s FAQ page or speak directly with an agent who will walk you through every step at no extra cost.
How do I know if a plan is good for managing chronic conditions next year?
Look at how well the plan covers the care you regularly need. Check whether your doctors and specialists are in-network, your medications are covered, and your expected out-of-pocket costs fit your budget. Coverage Fox can also help you compare plans based on your ongoing health care needs.
