Most dental insurance plans run on the calendar year, which means your unused benefits usually disappear on December 31. Your annual maximum starts over, your deductible resets, and any cleanings you didn't use are gone. If you have money left in a flexible spending account (FSA), that is often use-it-or-lose-it too. A quick call to your plan, or to us, can tell you what you have left so you can book before the year runs out.
What Resets When the Year Ends
Dental insurance works a little differently from medical insurance. Most plans pay up to a set amount each year, and anything you don't use is simply lost. Here are the benefits that usually start over on January 1:
- Your annual maximum. This is the most your plan will pay for your care in one year, usually around $1,000 to $2,000. Most plans do not let unused money carry over. A few plans have a rollover feature, so check yours.
- Your deductible. This is the amount you pay yourself before your plan starts paying for certain services. Once you have met it this year, finishing treatment now means you won't have to meet it again until January.
- Your preventive visits. Many plans cover two cleanings and exams a year. If you have only had one, the second one expires with the year.
Not every plan follows the calendar year. Some renew on a different date, such as the anniversary of when your employer started the plan. Your plan documents or member services line can tell you your exact renewal date.
Don't Forget Your FSA or HSA
Many people pay for dental care with pre-tax money from a work benefit account. The two most common types work very differently at year-end:
| Account | What happens at year-end | What to do |
|---|---|---|
| FSA (flexible spending account) | Generally use-it-or-lose-it. Some employers allow a short grace period or a limited carryover. | Check your balance and your employer's rules, then schedule care before the deadline. |
| HSA (health savings account) | The money rolls over from year to year and stays yours. | No rush, but you can still use it for dental care any time. |
FSA and HSA money can usually go toward your share of costs that insurance doesn't cover, such as your deductible, coinsurance or a crown.
Use Your Benefits Before December 31 Call (916) 929-3737 and we'll check what you have left, then find a time that works before your plan resets.
Splitting Treatment Across Two Plan Years
If you need more work than one year's maximum will cover, timing can help. For example, if you need two crowns, you might do one in December and the other in January. That way, each year's maximum helps pay for part of the work.
This does not work for every situation. Some treatment should not wait, and some steps need to happen in a certain order. Your dentist can tell you whether splitting care is safe for you and help you plan the timing. If you have a cavity or a cracked tooth, waiting too long can turn a simple filling into a bigger and more costly repair.
Your Year-End Benefits Checklist
Call your insurance plan, or call our office and we can look it up for you. Ask these questions:
- How much of my annual maximum is left? This tells you how much your plan can still pay this year.
- Have I met my deductible? If yes, more of your care is covered for the rest of the year.
- How many cleanings and exams do I have left? Many plans allow two a year.
- Do I have treatment that was recommended but not done? A filling, crown or other care your dentist suggested earlier may still be waiting.
- When does my plan renew? Confirm it is January 1 and not another date.
- How much is in my FSA, and what is the deadline? Ask your employer or benefits office.
Once you have the answers, book your visit. Many people remember their benefits in December, so year-end appointment times fill up quickly.
How Our Sacramento Office Helps
At Fulton Family Dental, we verify your benefits before your visit, file your claims for you, and give you a written estimate before any treatment. We are in-network with all Delta Dental plans and accept virtually every PPO plan. We do not take HMO plans or Denti-Cal. You can learn more on our insurance page.
If it has been a while since your last visit, a routine cleaning and exam is a great place to start. If your benefits won't cover everything, we also offer monthly payment plans through Cherry and CareCredit.
Frequently Asked Questions
Do unused dental benefits roll over to the next year?
Usually not. Most dental plans reset your annual maximum on January 1, and any amount you did not use is lost. A few plans have a rollover feature, so check your plan details or call member services.
When does my dental insurance reset?
Most plans reset on January 1 because they follow the calendar year. Some plans renew on a different date, such as the anniversary of your employer's plan. Your plan documents or member services can tell you your exact date.
Can I use my FSA for dental work?
Yes. FSA money can generally be used for dental care such as cleanings, fillings and crowns. FSA funds are usually use-it-or-lose-it, though some employers allow a short grace period or a small carryover. Check with your employer for your deadline.
What is an annual maximum in dental insurance?
It is the most your dental plan will pay toward your care in one plan year. For most plans it is around $1,000 to $2,000. After you reach it, you pay the rest yourself until the plan resets.
This article is general information, not a diagnosis or treatment plan. Every mouth is different. For advice about your own teeth, please schedule a visit or call (916) 929-3737.