A benefit year is the 12-month period during which your health insurance plan’s benefits apply. For most ACA Marketplace plans, the benefit year runs January 1 through December 31. Your deductible, out-of-pocket maximum, and other cost accumulators reset to zero at the start of each new benefit year.
The benefit year matters for planning your care and finances:
Employer-sponsored plans may have benefit years that don’t align with the calendar year. If your employer plan runs, for example, July 1 through June 30, your deductible resets on July 1.
No. Each plan year starts fresh. Deductibles, copay accumulators, and out-of-pocket maximums all reset to zero on day one of the new benefit year. Any cost-sharing you paid under your old plan does not transfer. This is especially important to factor in if you switch plans during Open Enrollment after already meeting your deductible late in the year.
Time high-cost, elective procedures for after you’ve already met your deductible for the year. If you reach your deductible in September, getting additional covered procedures before December 31 means your insurer pays a larger share. Waiting until January means starting over at zero.
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