What an ABA intake team checks before plans reset in January

The short answer

Between now and the end of December, some of the families you serve will change health plans, and plans that do not change can still start a new plan year on January 1. An intake team can use the next eight weeks to learn which families are changing coverage, collect the new plan documents as they arrive, and put re-verification of benefits on the calendar for the first days of January. None of this is new work. What changes is doing it in December, on a list, rather than after the first January claim comes back.

The dates, as of October 28, 2026

HealthCare.gov Marketplace plans. Open Enrollment for 2027 coverage starts November 1. December 15 is the last day to enroll in or change plans for coverage that starts January 1. Open Enrollment ends January 15, and coverage chosen between December 16 and January 15 starts February 1.^[1]

TRICARE. Open Season runs November 9 to December 8, 2026, and changes made during it take effect January 1, 2027.^[5]

Employer plans. There is no single date. HealthCare.gov defines a plan year as "a 12-month period of benefits coverage under a group health plan" and notes that it "may not be the same as the calendar year." Its advice for finding the start date is to check the plan documents or ask the employer.^[2]

Medicaid and CHIP. Not on this calendar. HealthCare.gov notes they are available at any time.^[1] Medicaid changes for an ABA clinic tend to arrive as a notice from the state agency on its own schedule, as with Virginia's pending 20-hour ABA limit.

What resets even when nothing changes

The family's cost share. HealthCare.gov defines the out-of-pocket maximum as the most a person has to pay for covered services in a plan year. For 2027 Marketplace plans it is no more than $12,000 for an individual or $24,000 for a family.^[3] A family that reached its limit in 2026 on a calendar-year plan starts counting again in January, so the first statements of the year can look different from the last ones.

What the plan covers. Keeping the same plan does not mean keeping the same terms. HealthCare.gov says the Summary of Benefits and Coverage arrives when someone shops for coverage, renews or changes it, or asks the insurer for one.^[4] The new SBC is the document to ask for, from every family.

What it means for intake this quarter

The caseload and the waitlist split into three groups, and each needs a different check.

Switching plans. New payer, new member ID, possibly a different network status, and an open question about authorization. Whether an existing authorization means anything to a new payer is that payer's answer to give. Ask it before the first January session.

Renewing the same plan. Same payer, new plan year. The cost-share counters start over, and benefits may have changed in the renewal. Re-verify rather than assume.

Waiting to start. A family expected to start in January or later should be verified against the plan they will have then. A verification done in October on a plan that ends December 31 describes coverage the family will no longer have when services begin.

What to do this week

1. Add one question to intake and check-in calls through December: "Is your health plan changing next year, or is anyone in the household changing jobs or benefits?" Record the answer and the date it was given.
2. Pull a list of clients with commercial or Marketplace coverage, grouped by payer, with each authorization's end date. Authorizations that run past December 31 under a plan that is changing go to the top.
3. Ask families who are changing coverage for the new card and the new SBC as soon as they have them. Ask in November and again after December 15, when Marketplace choices for January are settled.^[1]
4. Book re-verification for the first business days of January for every commercially insured client, including the ones who reported no change. A family can renew without noticing what changed in the plan.
5. Prepare the cost conversation. Where a family's out-of-pocket counter resets, the person who answers billing questions should raise it before the first statement, using numbers from that family's own plan documents.
6. Note the plan behind every waitlist verification, and re-check coverage when a family's start date gets close.

Where the check breaks down

The answer stops at the front desk. A parent mentions a new plan at pickup, and the person who handles authorizations hears about it in January. Decide now who records the answer and where.

A verification with no plan year on it. "Verified, October" says nothing about January. Record the plan, the plan year, and the date checked together.

All of January lands on one person. Re-verifying every commercial client in one week is a lot of calls to payers. Splitting the list by payer, and starting with the families who reported a change, spreads it out.

For what it's worth, the one question in step 1 does most of the work. The rest is a list the clinic already keeps, sorted by a date.

Where this does not fit

A mostly Medicaid caseload. January matters less. The state agency's notices matter more.

Employer plans that renew mid-year. The same checks apply, on that plan's date instead of January 1.

The details of any one payer. To be clear, this post describes HealthCare.gov's and TRICARE's published dates and definitions as of October 28, 2026. It does not say how any payer handles authorizations across a plan change, and it is not billing or legal advice. Confirm with each payer before acting.

How much of this to formalize is your call. A clinic with twenty families can run it from one column in a spreadsheet.