January is the month of the “healthcare hangover.” You diligently picked your plan during Open Enrollment last fall. You assumed your costs were fixed for the year. Then the first Explanation of Benefits (EOB) arrives in February. Suddenly, you owe money for visits that were free in December. You find charges for services you thought were covered.
This happens because the healthcare calendar resets on January 1. Deductibles return to zero. Contracts change. Inflation adjustments kick in. In 2026, specific statutory increases have made this reset particularly expensive. You might not notice these costs until you try to use your card. Here are the eight specific costs that catch seniors off guard after the New Year.
1. The Part B Deductible Reset
This is the most common surprise for beneficiaries with Original Medicare. You likely haven’t paid a doctor’s bill in months. That is because you met your deductible long ago. On January 1, that clock reset. The 2026 Part B deductible is $283. You must pay the first $283 of any doctor’s visit or test out-of-pocket. Until you hit that number, Medicare pays nothing. Your first appointment of the year will almost certainly generate a bill.
2. The Part D Pharmacy Sticker Shock
You might expect your prescriptions to cost the same as they did in December. They won’t. Most drug plans have a separate deductible. For 2026, plans can charge a deductible of up to $615. Until you pay that amount, you cover the full retail price of your meds. If you take expensive brand-name drugs, your first trip to the pharmacy could cost hundreds of dollars. This applies even if you reached the “catastrophic” phase last year.
3. The Wellness Visit “Upcharge”
Medicare covers an “Annual Wellness Visit” for free. However, if you ask the doctor about a new pain, the billing code changes. It becomes a “diagnostic” visit. You are then subject to the 20% Part B coinsurance. A simple conversation about a sore knee can turn a free checkup into a billable event. This often happens in January when seniors save up their complaints for the annual exam.
4. The Observation Status Bill
You might spend three days in a hospital bed but never be “admitted.” If the hospital classifies you as “Observation,” you are an outpatient. You face a 20% coinsurance on every single test and pill. Unlike inpatient stays, there is no single deductible. The costs for an observation stay are uncapped under Original Medicare. This billing distinction often results in a bill thousands of dollars higher than an inpatient deductible.
5. Part B Excess Charges
If you see a doctor who does not accept “Medicare Assignment,” they can charge you extra. This is called a Part B Excess Charge. They are allowed to bill you 15% above the Medicare-approved amount. Many seniors do not realize their doctor is a “non-participating” provider until the bill arrives. This 15% surcharge is not covered by standard Medicare. Unless you have a Medigap Plan F or G, you pay this directly.
6. Advantage Plan Copay Hikes
Medicare Advantage plans change their contracts every January 1. You may not have noticed the fine print in your “Annual Notice of Change.” Specialist copays often rise by $5 or $10. A visit to your cardiologist that cost $40 last year might cost $50 now. While small, these increases add up for chronic conditions. You are locked into these new rates for the rest of 2026.
7. The “New” Part D Cap Confusion
You may have heard that drug costs are capped at $2,000. That was the target in the Inflation Reduction Act. However, the indexed cap for 2026 is actually closer to $2,100. Seniors who budgeted strictly for a $2,000 maximum may be surprised. You will still owe copays until you hit this specific indexed threshold. It is not a hard stop at exactly $2,000 for every plan.
8. Routine Dental and Vision Exclusions
January is often when seniors schedule routine maintenance. They visit the eye doctor or dentist. Original Medicare does not cover these “routine” services. Unless you have a separate policy or a specific Advantage plan, you pay 100%. Even with an Advantage plan, the “allowance” may have reset to a lower amount for 2026. Always verify your new year’s benefit limit before sitting in the chair.
Read Your EOBs Carefully
Do not auto-pay your medical bills this winter. Wait for the Explanation of Benefits (EOB) from your insurer. Match the “Patient Responsibility” amount on the EOB to the bill from your doctor. If the doctor billed you before the deductible was calculated, they might owe you a refund. In the chaos of the January reset, billing errors are rampant. You must be your own auditor.
Did your first doctor’s visit of the year cost more than you expected? Leave a comment below—share your deductible horror stories!
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