As we enter a new year, insurance benefits, copay amounts, and deductible resets may bring changes to your healthcare coverage. Here’s what to expect when your plan updates on January 1, 2025.

What is an insurance renewal?

Each year, insurance companies adjust their rates and coverage options, giving you the chance to renew your current plan or choose a new one. During these annual updates, insurers update plans based on inflation, new medications, and other market changes. It’s also an opportunity to reassess your health insurance needs to ensure your plan aligns with your healthcare goals. 

If you had health insurance this past year, you likely participated in an “open enrollment” period in the fall. During this time, you reviewed any changes to your plan and confirmed which benefits would continue. You then had the choice to renew your current plan for another year or switch to a different option.

Why are insurance renewals important right now?

Most health insurance plans operate on a calendar year, so any changes take effect on January 1st. We recommend reviewing your plan updates now to avoid any surprises later.

Which insurance updates might impact me the most?

As you review your yearly changes, pay close attention to the following factors, as they could significantly affect your budget.

Your monthly premium 

Your premium is the cost of your health insurance plan each month. It’s common for premiums to change slightly from year to year, so be sure to double-check if yours is increasing for the coming year.

Your copays and deductible

Your deductible is the amount you pay for healthcare services before your insurance provider starts to help cover the costs. For example, if your deductible is $2,500, you’ll need to cover that amount out of pocket before your copay takes effect. Some plans have a combined deductible, covering both medical and prescription costs, while other plans have  separate deductibles for each.

Most deductibles reset at the beginning of the year, which might lead to a temporary increase in your healthcare expenses until your deductible is met—so it’s wise to budget for this period. 

Your copays and coinsurance — the amounts you pay for services after you’ve met your deductible — may also change. Different types of health services can have different copays, so be sure to review those that you anticipate using most.

Formulary changes 

A formulary is a list of generic and brand-name medications that are covered by your insurance company. It includes tiers that indicate which medication versions are preferred by your insurer and therefore offered at a lower out-of-pocket cost for you.

If you’re currently on prescription medications, confirm that your plan still covers them, especially if the medication is a branded drug. You may also want to ask your healthcare provider if there’s a more affordable version available. If you fill your prescriptions with Alto, we can review cost-saving options for you and let you know of any alternatives that could lower your expenses.

For more information on common insurance terms, check out this helpful glossary from JDRF.

What can I do if my medications are more expensive?

Navigating insurance updates can be confusing, especially if you discover increased costs for your medications. If copay changes or deductible resets affect your out-of-pocket expenses, Alto will explore any available savings options to help make your medication as affordable as possible. 

If your insurance company requires a written request from your doctor to keep you on the same medication due to formulary tier changes, we’ll coordinate this process with your doctor and keep you informed the whole way.

Read more about prior authorizations. 

Is there good news?

Yes! Your updated insurance plan may include new benefits that can save you money and support your health. Look for perks such as:

• Free annual exams and preventative care

• Discounts on fitness and nutrition programs, gym memberships, chiropractic care, and more

• Savings on health and wellness products

• Reduced rates for vision care 

Many people overlook these extra benefits, which can mean missed savings. Make sure to take advantage of everything your plan offers.

The benefits of a better pharmacy

As you plan for the coming year, don’t forget the benefits of choosing a better pharmacy. With Alto, you’ll get support with insurance and savings investigations, convenient courier delivery or nationwide shipping, and access to expert pharmacists seven days a week.

Reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Editor’s Note: This post was originally published in January 2021 and has been updated for accuracy and completeness.