Why Do I Have to Meet My Deductible Three Times in 9 Months?

Individual/Marketplace Insurance Forum
1

I’m on my wife’s employer-provided health plan, which originally ran from June 1 to May 31. But someone at her company complained about the deductible not aligning with the calendar year, so they changed it to run from Jan 1 to Dec 31. The plan itself didn’t change—just the deductible cycle.

The problem? Everything we had paid toward the deductible between June and December 2024 got cut off early, forcing us to start over on Jan 1, 2025. And then, in April 2025, I go on Medicare—resetting the deductible yet again.

To make matters worse, my wife had a medical emergency on Dec 23rd and was hospitalized until Dec 27th. The deductible reset just five days later, so none of those charges applied to the new cycle.

We’ve contacted an advocate from our insurance company to see if there’s any kind of continuation-of-care clause that could help when medical treatment starts in one deductible period and carries over into the next. Has anyone dealt with something similar? Any advice?

(Cross-posted in r/insurance and r/healthinsurance.)

3

This happened to me once! Our deductible reset, but six weeks later, the employer worked out an agreement with the insurance company to carry over deductible and out-of-pocket max expenses. Definitely check with HR first before reaching out to the insurance company.

4

@Rin
Thanks for the suggestion. We’ll check with HR and see if they have any options.

5

It’s entirely up to your employer whether they allow deductible carryover or not. If they did, it would apply to everyone in the plan automatically—it’s not something they can approve for just one person. You might want to ask HR if they’ve considered making that adjustment.