If you have dental insurance, part of it may reset soon. Knowing how your plan works before your plan year ends can help you avoid losing coverage you have already paid for, and avoid a surprise in the new year.
Five things to check
At a glance
- Many dental plans have an annual maximum and a deductible that start over each plan year.
- Your plan year may not be the calendar year, so check your end date.
- Unused benefits often do not carry over, but plans differ.
- Book care you already need. A deadline is never a reason for treatment you do not need.
This guide is general. Every plan is different, so your own plan documents decide what applies to you.
How most dental plans work
Most dental plans share a few features, though the names and amounts vary:
Annual maximum
The most your plan will pay toward your care in one plan year.
Deductible
What you pay before the plan starts paying for certain services.
Coinsurance
The share of a bill you and the plan each pay after the deductible. Preventive care is often covered at a higher percentage than major work such as crowns.
Plan year
Often the calendar year, but an employer plan can run on a different schedule.
When a new plan year begins, the annual maximum and deductible typically reset. Unused benefits often do not roll over, although some plans are different. Your benefits booklet or your insurance company can tell you for certain.
Key takeaway
The date that matters is your plan year end date, and it is not always December 31. Find it first.
Five things to check before your plan year ends
- Your plan year end date. Do not assume it is December 31.
- How much of your annual maximum is left. Your insurance company can tell you.
- Whether you have met your deductible. If so, treatment later in the year may cost you less out of pocket.
- Waiting periods and frequency limits. Some plans wait before covering major work, or limit how often a service is covered.
- Whether treatment needs pre-approval. If it does, allow time for that before your plan year ends.
Do not let a deadline make the decision
Benefits are a good reason to schedule care you already need. They are not a reason to have care you do not. If a dentist recommends treatment, ask why it is needed and what could happen if you wait. If something can safely be done next year, it is fine to ask about that too.
Sometimes a larger treatment plan can be spread across two plan years when that is also the right way to care for your teeth. Whether that helps with coverage depends on your plan, so ask your dentist and your insurance company before you decide.
Practical advice
Write down what you want to ask before you call: your remaining maximum, your deductible, and any frequency limits. Having those numbers makes the conversation about treatment much easier.
Flexible spending and health savings accounts
Health flexible spending accounts (FSAs) and health savings accounts (HSAs) can often be used for dental expenses. The rules differ by account and by employer, so ask your plan administrator whether unused money carries over or expires, and by when.
Next steps with our office
Our Financing page says Centre Dental Care accepts most dental insurances. Every plan is different, so contact the office to ask about yours before you schedule treatment. If you would like to spread out the cost of care, the Financing page lists the payment options currently available.
Frequently asked questions
Does dental insurance roll over to the next year?
Usually not. Many plans reset the annual maximum and deductible each plan year, and unused benefits often expire. Plans vary, so check your policy.
What happens to my unused benefits?
In many plans they expire at the end of the plan year. Your policy or your insurance company can confirm what applies to you.
Can I start treatment this year and finish next year?
Often it is possible, but how a plan counts treatment that spans two plan years depends on the plan and the type of treatment. Ask before you begin.
What if I do not have dental insurance?
Contact the office to talk through your options. Our Financing page lists the payment plans currently available.
Questions about your plan
Talk with our team
Contact the office and we will help you understand your options before you schedule care.
Visit us212 Kenlee Dr.
Bellefonte, PA 16823
HoursMon–Thu 8:00 AM–4:00 PM
Friday by appointment only
Closed Saturday and Sunday
This article is general information and not a guarantee of coverage. Coverage, limits and costs depend on your individual plan.
Sources
Centre Dental Care: Our technology
National Institute of Dental and Craniofacial Research: Periodontal (Gum) Disease
