Every November the phones get busier, and the question is almost always the same: "I think I still have insurance left this year — should I come in?"
Often the answer is yes. But not for the reason people expect, and not for everything. Here is how dental benefits usually work at the end of the year, and how we think about using them.
What resets in January
Most dental plans run on the calendar year. On January 1, three things usually start over:
- Your annual maximum. This is the most your plan will pay toward your care in a year — often somewhere between $1,000 and $2,000. On most plans, whatever you don't use is simply gone; it does not roll into next year.
- Your deductible. If you have already paid this year's deductible, the rest of your care this year doesn't need to clear it again. In January it starts from zero.
- Your preventive visits. Many plans cover two cleanings and exams a year. If you've only had one, the second is usually already paid for.
Some plans run on a different benefit year, and a few allow unused money to carry over. Your plan documents — or a quick call to us — will tell you which kind you have.
Flexible spending accounts are stricter
If you set aside pre-tax money in a flexible spending account (FSA) through your employer, unused funds are generally forfeited at the end of the plan year. Some employers offer a short grace period or let a limited amount carry over, but many don't. It's worth checking your balance now rather than in late December.
A health savings account (HSA) is different: the money stays yours and rolls over year to year, so there is no deadline pressure.
What's worth doing before the reset
- A cleaning and exam you haven't used yet. This is the easy one. It is usually fully covered, and it's how small problems get found while they're still small.
- Treatment that has already been recommended. If we found a cavity or a cracked filling at your last visit and it's been waiting, doing it before the year closes means it comes out of this year's maximum and deductible — not next year's.
- Larger work that can be split across two years. Some treatment plans — several crowns, for example — can be staged so part falls in December and part in January, using two years of benefits instead of one. When it's clinically sensible to stage, we'll lay that out for you.
What isn't a reason to book
A remaining balance on your plan is not, by itself, a reason to have something done. Benefits are a way to pay for care you need; they aren't a budget to spend down.
If something can safely be watched — a small area we're monitoring, a filling that's worn but sound — we'll tell you that, and we'll say so even in December. The plan we write for you is based on what your mouth needs, not on what's left on your card.
A simple year-end checklist
- Check how much of your annual maximum you've used. Your insurer's website or app usually shows it, or we can look it up for you.
- Check your FSA balance and your employer's deadline.
- Look back at your last visit: was anything recommended that hasn't been done?
- If you haven't had your second cleaning this year, schedule it now — December appointments fill first.
If you're not sure where you stand, call us at (301) 292-0900. We'll check your remaining benefits and tell you plainly what's worth doing this year and what can wait. You can also read more on our insurance & financing page.
