Your Deductible Is Met—Now May Be the Time for Foot Surgery

KEY TAKEAWAYS:

• Meeting your deductible may lower your costs. If you have already met your annual deductible, your insurance plan may cover a greater share of eligible foot surgery expenses before the plan year resets.
• FSA funds may be worth reviewing. Depending on your plan, unused FSA dollars may need to be spent before a deadline. HSA funds generally roll over from year to year.
• Year-end surgery can offer practical advantages. Available time off and the opportunity to begin recovery before the new year may make scheduling more convenient.

If you’ve spent months dealing with a painful bunion, hammertoe, heel problem, or another foot condition, you may be considering surgery. But for many patients, having surgery isn’t just about deciding to have a major medical procedure; it’s also about whether or not they can afford it.

For some patients, year-end can provide a valuable window for scheduling medically appropriate foot surgery. Many patients have met their deductible toward the end of the year, and at that point, an insurance plan generally begins paying a greater share of covered medical costs. A podiatrist can help determine whether surgery makes sense medically, while your insurer can explain exactly how your individual plan handles the procedure. Here, our knowledgeable podiatrist, Dr. Sarah Stewart, discusses why scheduling year-end foot surgery can be financially prudent. 

Why Meeting Medical Deductibles Can Make Year-End Foot Surgery a Wise Decision

A deductible is the amount you pay for covered health care before your insurance plan begins paying its share. Once that threshold has been reached, you may pay only the applicable copayment or coinsurance for covered services for the remainder of the plan year.

That can make timing worth considering when foot surgery is already medically appropriate. If your plan year resets in January, your deductible may reset as well, potentially changing what you pay toward covered care.

The same principle applies to the out-of-pocket maximum. For many plans, once you reach that limit through eligible deductibles, copayments, and coinsurance for covered in-network care, the plan pays 100% of covered benefits for the remainder of the plan year.

Before scheduling, contact your insurance company to ask about the following:

• Your remaining deductible. Confirm whether you have actually met the deductible that applies to the proposed procedure.
• Your coinsurance or copayment. Meeting a deductible does not necessarily mean surgery is free. Other cost-sharing requirements may remain.
• Network requirements. Confirm that the surgeon, surgical facility, anesthesia provider, and other involved providers are covered under your plan.
• Authorization requirements. Ask whether the procedure requires prior authorization or other documentation.

What Are the Advantages of Scheduling Foot Surgery Before Year-End?

Money should never be the only reason to have surgery. However, when a podiatrist has already determined that surgery is an appropriate treatment option, year-end timing may offer practical benefits. Depending on your procedure and lifestyle, potential advantages include:

• Starting the new year in recovery. Having surgery late in the year may allow you to enter the next year already progressing through the healing process rather than postponing treatment for several more months.
• Using available time off. Some patients find that accumulated vacation or personal leave makes it easier to arrange time away from work near year-end.
• Planning recovery around your schedule. Foot procedures can temporarily affect walking, driving, work, exercise, and household responsibilities, making advanced planning valuable.

Recovery requirements vary widely by procedure. For example, some foot surgeries may require a surgical shoe, crutches, a scooter, limited weight-bearing, or several weeks of activity restrictions. Our podiatrist can explain what to expect based on the specific operation being considered.

Using FSA or HSA Funds to Help Pay for Foot Surgery

Year-end may also bring another financial consideration: money set aside for health care expenses.

Health Flexible Spending Accounts (FSAs) generally operate under “use-it-or-lose-it” rules, although some employer plans permit a limited carryover or grace period. If you have FSA dollars remaining, eligible surgery-related expenses may allow you to use those funds rather than forfeit them. Check your plan documents or with a benefits administrator for the rules that apply to your account.

Health Savings Accounts (HSAs) work differently. HSA balances generally roll over from year to year, so there is no requirement to spend the money simply because December is approaching. HSA funds can generally be used tax-free for qualified medical expenses.