How to Use Your Dental Benefits Before They Reset

Dental insurance is not health insurance, and the differences catch people out every December. The single most useful thing to understand is that most plans operate on a calendar year and most of what you do not use simply disappears on the 31st.

Which Three Dental Insurance Numbers Matter?

Almost every question about dental benefits comes back to three figures.

The annual maximum. This is the most your plan will pay toward your care in a plan year. Once you reach it, the plan stops contributing until the year resets. Unused room almost never carries forward. The deductible. This is what you pay before the plan starts paying. It resets each plan year, which is why finishing treatment inside one year rather than straddling two sometimes matters. Frequency limits. Plans cover certain services a set number of times per year. Unused visits do not bank. Skipping them this year does not give you extra next year.

Our team can pull all three for your specific plan. It takes a few minutes and there is no obligation attached to asking.

Why Do Dental Benefits Expire?

Dental plans are structured more like a yearly allowance than like medical insurance. The insurer budgets a fixed amount per member per year, and the arrangement assumes most people will use routine preventive care and some will need more.

From the patient side this produces an odd incentive. Care you have already paid premiums for becomes worthless if you do not use it before the deadline.

That is the whole reason the end of the year gets busy in dental offices. It is not a sales tactic. It is a deadline built into how the plans are written.

What Is Worth Scheduling Before Benefits Reset?

If you are trying to make good use of remaining benefits, the usual candidates:

• Preventive visits your plan covers that you have not used this year. Our post on what happens at a cleaning covers what these involve.
• Treatment your dentist already recommended that you postponed.
• A crown or filling that has been waiting.
• A night guard, if grinding has come up at a previous visit.
• Larger treatment that will take more than one appointment.

That last one deserves its own explanation.

How Does Treatment Spanning Two Plan Years Work?

When treatment requires several appointments, there is sometimes a scheduling question worth raising.

Beginning treatment before the reset and completing it afterward means two separate plan years are involved, each with its own maximum. For some patients and some treatment plans, that changes what ends up covered across the whole course of care.

Whether it applies to you depends on your plan, the specific procedures, and above all on the clinical timing. No one should stretch treatment out for insurance reasons if that is not appropriate for the tooth.

It does require planning, so if you have significant treatment ahead, raise it in October or November rather than the week before Christmas.

What If You Do Not Have Dental Insurance?

Plenty of our patients do not, and the year-end deadline is irrelevant to them.

Our membership plan is built for exactly that situation, and covers preventive care without the annual maximum structure. Details are on the insurance and financing page.

For larger treatment, financing options including CareCredit let you spread the cost over time. Our front desk can walk you through what is available before you commit to anything.

How Do You Get a December Appointment?

The practical problem with December is not benefits. It is capacity.

School holidays, travel, and every other patient having the same realization all land in the same three weeks. The appointments that remain tend to be the ones nobody wants.

October and November are simply easier. If you know you need something done, calling now gets you a time that fits your schedule rather than one you have to work around.

Where Is Mountainside Dental Located?

Frequently Asked Questions