As we approach the end of 2025, now is the perfect time to evaluate your healthcare needs and maximize your insurance benefits. At Florida E.N.T. & Allergy, we want to help you understand your coverage and ensure you’re getting the care you deserve before your benefits reset.
About Your Insurance: Key Terms Explained
Navigating insurance terminology can feel overwhelming. Here’s a simple breakdown of the most important terms:
Deductible: This is the amount you pay out-of-pocket for covered healthcare services before your insurance plan starts to pay. For example, if your deductible is $1,500, you’ll pay the first $1,500 of covered services yourself, and then your insurance begins to share the costs.
Out-of-Pocket Maximum: This is the most you’ll pay for covered services in a plan year. Once you reach this limit, your insurance pays 100% of covered benefits for the rest of the year. This includes your deductible, copays, and coinsurance, but typically not your monthly premiums.
Copay: A fixed amount you pay for a covered healthcare service, usually at the time of service. For instance, you might have a $30 copay for a specialist visit. The amount can vary by the type of service.
Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage. For example, if your plan’s coinsurance is 20%, you pay 20% of the cost of the service, and your insurance pays the remaining 80%.
Why November & December Matter for Your Healthcare
The end of the year presents a valuable opportunity to maximize your insurance investment. Here’s why acting now makes financial sense:
1. You’ve Already Met Your Deductible or Out-of-Pocket Maximum
If you’ve met your deductible or reached your out-of-pocket maximum for 2025, your insurance is now covering services at the highest level possible. This means procedures, treatments, and appointments you’ve been postponing could cost you significantly less, or nothing at all, if you schedule them before December 31st.
When January arrives, your deductible and out-of-pocket maximum reset to zero, and you’ll need to start the process all over again. Don’t let the benefits you’ve already paid for go to waste!
2. HSA and FSA Funds May Expire
Many Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) have “use it or lose it” rules. If you have unused funds in your FSA, they typically don’t roll over into the new year. Using these funds for necessary healthcare services ensures you’re getting the full value of your pre-tax contributions.
Healthcare Services to Consider Before Year-End
At Florida E.N.T. & Allergy, we offer comprehensive care for a wide range of conditions. If you’ve been putting off treatment, now is the ideal time to address:
Allergy Testing and Treatment: Identify your triggers and start immunotherapy to find long-term relief from allergy symptoms.
Sleep Apnea Solutions: If you’re struggling with snoring, daytime fatigue, or disrupted sleep, we offer diagnostic testing and treatment options, including traditional CPAP or an alternative called Inspire Sleep Therapy.
Sinus Procedures: Chronic sinusitis doesn’t have to follow you into 2026. We provide advanced sinus procedures, including balloon sinuplasty, that can offer lasting relief from recurring infections and sinus pressure.
Hearing Aids: Better hearing improves communication, safety, and overall well-being. We offer comprehensive hearing evaluations and the latest hearing aid technology tailored to your lifestyle.
Other Ear, Nose, and Throat Concerns: From chronic ear infections to voice disorders, tonsil issues to thyroid conditions, our specialists are here to provide expert diagnosis and treatment.
Important Reminders
Planning to Change Insurance in 2026?
If you’re considering switching insurance plans for the new year, please let us know as soon as possible. This helps us verify your new coverage, ensure we’re in-network with your new plan, and prevent any unexpected billing issues. We want to make your transition seamless and keep your care uninterrupted.
Check Your Network Status
We participate with many major insurance plans. To verify your specific coverage and see our participating networks, please view our insurance information flyer or contact our office directly. Our knowledgeable staff is always happy to help you understand your benefits.
Take Action Today
Don’t let valuable insurance benefits expire unused. Here’s how to get started:
- Review Your Benefits: Check with your insurance provider to see how much of your deductible and out-of-pocket maximum you’ve met for 2025.
- Consider Postponed Care: Think about any symptoms or conditions you’ve been living with but haven’t addressed.
- Call Us: Contact Florida E.N.T. & Allergy to schedule an appointment. Our team can help you understand your coverage and get you in before year-end.
- Verify Your 2026 Coverage: If you’re changing plans, let us know so we can ensure a smooth transition.
Time is running out to maximize your 2025 benefits. The care you’ve been putting off could be more affordable than you think, especially if you’ve already met your deductible. Let us help you breathe easier, hear better, and feel your best.
Schedule your appointment with Florida E.N.T. & Allergy today to make the most of your insurance benefits before they reset.