As you start the New Year, be aware that the annual deductibles for most plans reset and start January 1, 2026. Traditional Fee for Service Medicare deductible for 2026 is $283. Other plan deductibles including Medicare Part D vary by insurance company and plan.
At this time of the year alerting your patients to their deductible status and submitting their claims on a timely basis is your way of assuring that claims and deductibles are properly processed as soon as possible.
One common scenario every year is how to avoid your patient’s claim being held up by the deductible when they paid this to another doctor they saw after you.
To avoid this problem, claims should be submitted daily, or even twice daily during the firsf few weeks of the year. This will avoid claims being paid by both the patient (when they are in your office) and then a few weeks later by Medicare. This accidental “double dipping” (as seen by the patient) now begins a booking nightmare for both practices.
Don’t forget that, especially for new patients, checking their deductible status throughout the year and not in January is equally important. This especially for patients with high-deductible plans. Which brings us to our next topic. Health Savings Accounts (HSA) or Flexible Savings Accounts (FSA).
Turning attention to Health Savings or Flexible Accounts
Many orthotic providers may not be aware that HSA or FSA will cover foot orthotics or other services that are not deemed medically necessary by the patient’s insurance carrier. Both FSA and HSA will reimburse patients for a wide variety of medical services, both covered but not paid due to a high outstanding deductible or non-covered services including foot orthotics. Simply provide the patient with a note of medical necessity and a receipt of payment.
The good news is that the wide variety of medical services covered under both FSA and HSA are not mandated by the patient’s insurance. Instead, the much more liberal listing of medical services covered by these savings accounts is under the jurisdictions of the IRS and is listed in Publication 969
This government publication defines HSA and how they work. In very simply terms the employee contributes tax free money (taken from the employees’ paycheck prior to the subtraction of Social Security and other taxes) to an HSA throughout the year. That money can then be used to pay for medical services which are not covered by the employer sponsored health plan or insurance deductibles. HSA will also cover medications (both prescription and non-prescription) not covered by the employee’s health insurance.
Once the employee contributes the money to the HSA, it normally must be used for services provided in that same year. Hence even if your patient asks you for a bill for orthotics provided in 2025 during 2026, even though you are providing them with a bill in 2026, as the services were rendered in 2025, the HSA can reimburse the patient for those expenses using 2025 funds. In most cases HSA are restricted to patients with high-deductible insurance plan however, the money contributed to the HAS/FSA in one year can roll over into the next year.
Other highlights of these flexible savings accounts: Employers can contribute additional funds to their employees HSA via payroll deductions.
The funds in the HSA belong to the employee, so even if the employee changes jobs, the funds are portable and can be transferred to a new HSA with the new employer.
Patients can grow a nice nest egg for services that are either non-covered or subject to a high deductible. Having this information to educate your patients can make your practice more attractive to patients. Hence, many practices heavily market the use of HSA funds to their patients, especially during the last two months of each calendar year. Also if you provide health insurance for your employees, you may want to provide HSA/FSA accounts for your employees. These additional employee benefits may attract more highly qualified worker and aid in retaining those currently in your employment.
For more information on HSA, refer again to IRS publication 969.
Insurance Plan Updates:
The good news is that many Federal and State regulations require insurance carriers to post these and notify you of changes to coverage policies. Many of these are updated annually and easy to find.
For example, United Health Care, has issued a new DME plan documents for 2026. For UHC this can be found here.
Having quickly reviewed this document, it appears consistent with Medicare policies and does not specifically mention foot orthotic coverage (that is a good thing!)
In most cases national policies for Cigna, United and others have local contracts which provide more specific details on foot orthotic coverage for your specific patient.
National policies are usually not reflective of those issues, and it is your patient’s specific insurance policy documents which often overrides the National policy.
To make sure you and your staff are up-to-date, one person in your practice(or you) should be assigned the task to both download and review these policy documents (both national and local). Staying educated on plan policies can keep you and your patients informed of any new developments.
Being an advocate for your patient and having the patient advocate for you and themselves has always been the best practice management tool. Referring patients to their Human Resources department or having someone in your office speaking with the patient’s Human Resource Representative, or Union Delegates is something every provider should become accustomed to. The HR folks are in touch with higher level contacts at the insurance carrier and can quickly cut through a great deal of red tape far more efficiently than your practice!
Lastly, some other good news is that there are no new substantial HCPCS codes changes or additions nor any new significant LCD (local carrier decisions) applicable to lower extremity orthotic providers.
Good luck and Good health to all in the New Year.
One-page quick guide: January deductible reset checklist
Front desk (before/at check-in)
- Run eligibility + benefits (deductible met? remaining? coinsurance? DME/orthotics benefit?)
- Confirm the patient’s address on file (important for many payers’ processing rules)
- Set expectations: “January is deductible reset season—today’s estimate may adjust slightly once claims finalize.”
Clinical team
- Document diagnosis, functional impairment, and the “why now”
- Ensure the order/prescription elements are complete (avoid downstream delays)
Billing (same day or next business day)
- Submit clean claims quickly (don’t let January visits sit)
- If collecting at time of service, clearly label as estimate pending payer processing
- If a balance changes after adjudication, communicate early and simply (refunds/adjustments happen—speed reduces frustration)
Here is a patient friendly script when confirming your patient’s first appointment of the year:
Susan, prior to seeing you on … we will be reviewing your insurance coverage for this new year. Have (or will) there been any changes you want to let us know about?
If none, we will check with the carrier on the day of your visit regarding your deductible status. You will be responsible for any charges subject to the deductible.
Where allowed by state law: Can we charge your CC on file and has that card changed or is it the same?
On the day they present to the office: Ask the same questions again and note any changes. Process the CC on file (again where allowed by State law) provide the patient with a receipt and submit the claim for payment on THAT DATE!
