What December Means for Your Dental Benefits

Types of Dental Insurance

Dental insurance is available through several sources. While most people receive coverage through their employers, private insurers also offer individual plans. Additionally, you can explore dental insurance options through the healthcare marketplace, though this usually requires purchasing a medical plan at the same time, or take advantage of an FSA.

Some of the most common types of dental insurance are:

• PPOs (Preferred Provider Organizations), which allow you to visit any in-network provider and often even out-of-network dentists without needing a referral. However, this convenience typically comes at a slightly higher cost due to the broader network of pre-selected providers.
  
  
• HMOs (Health Maintenance Organizations), which are generally more affordable but come with stricter limitations. You are required to choose from a set network of providers and often need referrals for specialist care. HMOs may not cover out-of-network services, so your options are more restricted.
  
  
• Dental indemnity plans, which let you see any licensed dentist without worrying about networks. However, this flexibility means you’ll generally pay a portion of each procedure’s cost out-of-pocket, rather than having certain services fully covered.
  
  
• Flexible Spending Accounts (FSAs), a valuable benefit offered through employers that can help you cover dental expenses using pre-tax dollars. During open enrollment, you’ll decide how much to allocate to your FSA for the upcoming year, with contributions automatically deducted from each paycheck before taxes. This account can be used throughout the year to pay for eligible dental services, such as cleanings, fillings, and orthodontics. 
  
  

What Happens to Your Dental Insurance at the End of the Year

While some plans might have varying end dates or use a “rolling calendar” system that extends benefits into the following year, the majority of dental insurance plans—traditional or FSAs—follow standard calendar schedule, resetting annually on January 1, and operate on a “use it or lose it” basis. 

This means that any unused funds or benefits left at the end of the year may be forfeited. 

Some plans may offer a brief grace period or allow a limited rollover, but it’s essential to plan your dental expenses carefully to avoid losing these benefits.

Here’s what the end of the year means for your…

Deductible.

A deductible is a set amount of money you have to pay out-of-pocket for any dental services before your dental plan coverage kicks in to help cover costs. For example, if your deductible is $100 and you need a filling that will cost $200, you will pay $100, then the insurance will pay for the remaining amount. 

With most dental plans, you do not have to pay a deductible for preventive dental care, since this is usually 100% covered.

At the end of the year, your deductible will reset. 

Annual Maximum.

Most dental insurance plans include an annual maximum, which is the highest amount your insurer will pay for dental care each year. This limit typically falls between $1,000 and $1,500, depending on your plan. 

At the end of the year, if you haven’t reached this cap yet, there’s still time to schedule additional treatments and maximize your benefits. 

If you have reached your annual maximum–which is rare–your claim may be denied and you’ll be responsible for paying any additional costs until your new benefit period begins.

Dental Benefits.

Dental benefits help pay for the cost of dental services, from preventive and basic restorative care to more extensive care like tooth replacement, oral surgery, and more. Your specific covered benefits will vary based on your plan, but most FSAs and dental insurance policies typically cover all or a portion of costs for both preventative and restorative care, including:

• Fillings and sealants
• Routine cleanings and exams
• Crowns and bonding
• Dentures, implants, and extractions
• Inlays, onlays, and other restorative procedures
• Diagnostic services like X-rays and fluoride treatments
• Treatment for gum issues like gingivitis, TMJ disorders, and gum recession
• Oral surgery and root canals
• Orthodontic treatments for medical or dental health reasons

Some plans may also cover expenses like co-pays, deductibles, and even certain oral pain remedies. However, coverage rarely extends to premiums or purely cosmetic services, such as teeth whitening, veneers, or cosmetic orthodontics.

At the end of the year, any benefits you haven’t used will not carry over into the new year; they will be forfeited, which means you’ll lose out on services that you have already paid for with your monthly premiums.

If your benefits have already expired, that’s ok. Open enrollment typically takes place toward the end of each calendar year and allows you to make changes to your existing plan or switch to a new one. This is a great time to reevaluate your dental coverage and ensure it aligns with your needs for the upcoming year.

What You Can Do to Make the Most of Your End-of-Year Dental Benefits

To get the most out of your dental benefits, you need to first gather some key information, such as:

Do you have employer-provided benefits, an individual plan purchased through the Health Insurance Marketplace, or an FSA provided by your employer?

What does your plan cover? Work with both your dentist and your insurance provider to understand which services are covered and how much your plan will pay.

What is your deductible, and have you met it this year? Knowing this can help you decide which treatments to prioritize before the year ends.

Will your dental benefits change next year? This could be due to a shift in employment or a change in coverage for you, your spouse, or your family.

What is your yearly maximum benefit? This is the total amount your plan will pay for your dental treatments within a year. The average maximum is around $1,000, and it resets annually.

Are you paying a premium, and if so, how much? If you’re paying for coverage each month, you’re earning benefits that you should be using. Skipping dental visits means wasting money on unused benefits.

Then, you can take steps to maximize your benefits by…

• Using any benefits before they expire, especially for preventative services like bi-annual cleanings and checkups, which most plans cover fully or nearly fully. If you haven’t had your annual exam, now is the perfect time to schedule it.
  
  
• Taking advantage of your benefits early. During your appointments, ask your dentist about any additional treatments you might need and what’s covered by your plan. Schedule those treatments as soon as possible to maximize your coverage, use your FSA dollars before the deadline, and avoid leaving money on the table.
  
  
• If you’ve already met your deductible, prioritize any necessary procedures, such as routine cleanings or fillings, before the year ends. This ensures that your insurance covers a portion, if not all, of the costs.
  
  
• Planning your FSA contributions carefully. Don’t allocate more than you anticipate using within a year. Before open enrollment, consult with your dentist to plan for any expected dental expenses, and reach out to your FSA administrator for details on your plan’s coverage limits and a list of “eligible expenses” to ensure you’re making the best use of your funds.
  
  
• Check if your employer offers extensions, such as a grace period of up to 2.5 months after December 31 or a small rollover into the next year, to make the most of any remaining funds.
  
  

If you’ve missed the deadline, use this time to plan ahead. Consider scheduling a dental consultation early in January to assess your oral health and prioritize any necessary treatments. Spreading out dental care throughout the year can help you avoid the last-minute rush in December. 

If you have access to open enrollment, review your plan options, especially if there are changes in your employment or coverage needs. It might also be wise to increase your FSA contributions or choose a plan with a higher annual maximum if you anticipate more extensive dental work in the coming year.

Make the Best Use of Your Dental Benefits with Dental Depot of KCMO

As a doctor-owned dental support organization (DSO), Dental Depot of KCMO operates like a family-owned practice, delivering high-quality dental care with a personal touch at an affordable, commonsense price. We know it’s important for you and your family to maximize your dental benefits before they expire at the end of the year. Whether you need a routine check-up, want to complete ongoing treatments, or are looking to make the most of your FSA funds, our dedicated team is here to help you get the most from your coverage. We take a personalized approach, working one-on-one with each patient to tailor treatment plans that fit your dental needs and budget. 

Choosing Dental Depot of Kansas City means partnering with a team committed to your oral health and overall well-being. We accept a wide range of dental insurance plans and offer flexible payment options to make exceptional dental care accessible for everyone. With multiple locations and Saturday appointments, we make it easy for you to fit the care you need into the schedule you have, even at the busiest time of year. Let us help you and your family take full advantage of your benefits so your smile stays healthy and bright into the new year. Schedule your appointment today and find out how Dental Depot of Kansas City can help you use–not lose–your dental benefits.