As the year draws to a close and you consider your health care situation as we enter the new year, be sure you don’t overlook your dental insurance benefits. Many dental plans reset on January 1, and you could lose access to coverage you haven’t used. If you’ve postponed a cleaning or recommended treatment, now is a good time to act and use your dental benefits before the end of the year.
Why Unused Dental Benefits Don’t Roll Over
Most dental insurance plans operate on a calendar-year basis, with coverage beginning January 1 and continuing through December 31. In other words, if your plan has a $1,500 annual maximum and you only use $500, the remaining $1,000 disappears when your benefit year ends. This means unused dental insurance benefits represent missed opportunities to receive covered care.
However, December 31 isn’t everyone’s deadline. Check your policy before you assume your dental benefits expire at year-end. If you have remaining coverage, schedule recommended treatment before your plan resets to avoid paying more out of pocket next year.
Annual Maximums, Deductibles, and FSA/HSA Funds Explained
Dental insurance policies have limits you should account for to make sure you’re making the most of your coverage. Three important factors affect how much you’ll pay.
Annual Maximums
Your dental annual maximum is the most your insurance company will pay toward covered services during a benefit year. For example, suppose your plan has a $2,000 annual maximum. If your insurer has already paid $800 toward treatment, you may have $1,200 remaining.
This doesn’t mean you can receive $1,200 in free dental care. Your plan may require copayments or coinsurance, and some treatments may not qualify for coverage. Review your remaining maximum when planning treatment to maximize your dental insurance benefits.
Deductibles
A deductible is the amount you must pay for covered services before certain insurance benefits go into effect. If you have a $100 deductible and have already met it, you shouldn’t need to meet it again until your dental insurance deductible resets next year. Some plans also waive deductibles for preventive services like routine examinations and cleanings.
FSA and HSA Funds
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) let eligible individuals pay qualified healthcare expenses using tax-advantaged funds. You can often use these accounts for eligible dental expenses, including cleanings, fillings, extractions, and medically necessary orthodontic treatment. However, these accounts have different expiration rules:
- FSAs – These accounts generally follow a use-it-or-lose-it rule. If you want to use FSA funds before the end of the year, check your employer’s deadlines first. Some employers allow limited carryovers or a grace period for spending remaining funds.
- HSAs – Unused funds remain in your account and carry forward to future years. You don’t lose your balance on December 31.
Treatments Worth Scheduling Before December 31
If you’ve delayed any dental care you need, you should treat the final months of the year as an opportunity to address those outstanding needs. Depending on your remaining benefits and your dentist’s recommendations, consider scheduling the following treatments before December 31.
Routine Cleanings and Exams
Regular dental visits help identify oral health problems like cavities and gum disease before they worsen. Many insurance plans cover preventive services at a higher percentage than restorative treatments. Some also cover two cleanings per year. If you’re due for a cleaning, scheduling it now may help you take advantage of your remaining preventive benefits.
Fillings and Crowns
Untreated cavities can progress and cause further tooth damage, but fillings (which restore teeth affected by decay) and crowns (which protect teeth with more extensive damage) can help. If your dentist has recommended either procedure, review your coverage before pushing treatment off to next year. You may be able to apply your remaining annual benefits toward the cost.
Periodontal Treatment
Gum disease can damage the tissues and bone supporting your teeth. Depending on its severity, treatment may include deep cleaning, also called scaling and root planing. Your dental insurance may cover periodontal treatment, although coverage varies based on the procedure and your plan’s limitations. If possible, consider pursuing any recommended periodontal treatment to help prevent further damage and reduce the need for additional treatment later on.
Root Canals and Other Restorative Procedures
A root canal procedure may help save an infected or inflamed tooth. Other restorative treatments, including bridges and dentures, can address damaged or missing teeth. These procedures may require multiple appointments, and starting the process before year-end could allow you to use your remaining coverage, depending on your plan’s rules.
Orthodontic Treatment
Some dental plans offer orthodontic benefits for braces or other medically necessary corrective treatments, although orthodontic coverage often has separate limits, including lifetime maximums. Check your policy before scheduling treatment, especially if you plan to use FSA or HSA funds.
How to Check What You Have Left and Book Before the Holiday Rush
While dental insurance policies can be hard to interpret at times, you don’t have to guess how much coverage you still have for the current year. Take these steps to better understand your benefits and schedule the care you need before the year ends:
- Review your insurance account. Log in to your insurer’s website or app to check your annual maximum, deductible, and remaining benefits. Confirm when your benefit year ends.
- Check your treatment coverage. Review which procedures your plan covers, along with any waiting periods, frequency limits, or exclusions.
- Contact your dental office. Ask about available appointments and discuss the possibility of scheduling any recommended treatments you’ve postponed.
- Request a cost estimate. Your dental office may help you obtain a pretreatment estimate from your insurer so you understand your expected expenses.
- Review your FSA balance. Contact your benefits administrator to confirm spending deadlines, carryover provisions, and reimbursement requirements.
End-of-year dental appointments can get more challenging to schedule as the holidays approach. Booking early gives you more flexibility. If your dental insurance renews in January, ask whether scheduling treatment across benefit years makes financial sense.
Schedule an Appointment with Babylon Dental Care
Don’t let the year end without reviewing your dental benefits. Whether you’re due for a routine cleaning or need restorative treatment, Babylon Dental Care can help you plan your next steps. Contact our office today or call (631) 983-6665 to schedule an appointment and make the most of your remaining coverage.