Use It or Lose It Dental Benefits: A Year-End Guide

Use it or lose it dental benefits means the part of your yearly dental coverage that you do not use may not carry into the next plan year. Your plan year may not end on December 31, so check your renewal date on your insurance card, in your insurer's portal or with your employer's HR, then book early.

This article is general information about how dental plans commonly work. Your own plan documents control what applies to you.

Key takeaways

• Many dental plans run on a calendar year, but some run on a different plan year, so confirm your renewal date.
• Your annual maximum is the most the plan pays in a plan year. Unused amounts typically do not carry over, although plan rules vary.
• Deductibles generally start over when your coverage renews.
• Your insurer, plan documents or portal show what is left. Ask the dental office for a breakdown before treatment.
• Schedule early. Appointment availability can be limited near the end of the year.
• Timing should follow clinical need. Do not start treatment you do not need just to use up a benefit.
• A flexible spending account (FSA) has its own year-end rules.

What "use it or lose it" means

Dental insurance gives you coverage for specific services up to defined limits within a benefit year. The American Dental Association (ADA) explains in its guide to choosing a dental plan that the annual limit is the total dollar amount a plan will pay during the plan year. If your costs go over it, you owe the rest. The same guide notes that your deductible applies for the year or period specified, and a new deductible applies when your coverage renews.

You pay your premium whether or not you use your benefits. When the plan year ends, the unused part of the annual maximum typically does not roll over. Some plans have different rules, so the plan documents are the final word.

Step 1: Find your reset date

The ADA notes that most dental plans are based on a calendar year or on a plan year that can vary by group. Many employer plans follow a calendar year, but yours may renew on another date. To check:

• Look at your insurance card and plan summary.
• Log in to your insurer's website or app.
• Ask your employer's HR or benefits administrator.
• Call the number on your card.

Step 2: See what you have left

Your plan documents list your annual maximum, deductible, covered services and what you have used. Your insurer's portal or a call to the insurer can confirm your remaining balance.

Plans usually sort care into preventive, basic and major services, and the share you pay differs by category. The ADA notes that some services, such as cleanings and diagnostic services, may be covered automatically with no deductible.

Clio Dental Studio works with most major PPO plans and gives you a breakdown before treatment. If you are not sure whether the practice accepts your plan, the team can walk you through it. See insurance and ways to pay for new patients.

Step 3: Time your visits

Planning dental visits before benefits reset can help you use coverage that would otherwise expire.

• Book early. Scheduling sooner rather than later can help you avoid limited appointment availability near the end of the year.
• Start with preventive care. A cleaning and exam is a common way to use benefits and to find out whether you need other care.
• Ask about estimates. Some insurers will give an advance estimate for larger treatment. The ADA notes in its introduction to dental benefits that a predetermination is not a guarantee of benefits, because your available benefits can change before treatment is done.
• Let clinical findings lead. When appropriate, your dentist can discuss how care might be phased across benefit periods, while keeping the plan in line with what your mouth needs.

Larger treatment, such as implants, crowns or full-arch work, takes more than one visit. If you are weighing a bigger plan, a complimentary consultation can explain the steps and sequence so you can decide on timing. See dental implants for one example.

If you feel nervous about going

Some people put off care because they feel anxious about treatment. Dr. Sanaz Rouhani is sedation certified for patients who feel anxious. You can read more on her profile, and you can talk with the team about your concerns before you book.

Flexible spending accounts

An FSA lets you pay eligible expenses, including dental, with pre-tax money. FSAs are generally use-it-or-lose-it, and the rules come from your employer's plan, not your dental plan. According to HealthCare.gov, an employer may offer either a grace period of up to 2 1/2 extra months or a limited carryover, but is not required to offer either, and cannot offer both. Anything not used or carried over by the deadline is lost. The IRS explains the same rules in Publication 969. Check your own plan's deadline and any claim cutoff date.

If you do not have dental insurance

The Clio Care Plan is the practice's in-house membership for patients without insurance. It includes preventive care and 15% off procedures at the practice. It is not insurance. See the dental membership plan. Financing is also available through Alphaeon, CareCredit, Cherry and Sunbit, and no insurance is needed to apply. See payment plans and financing.

What it costs to wait

When benefits expire unused, you lose coverage you paid for during the year. If benefits reset before treatment is finished, you may face a new deductible and your out-of-pocket costs can be higher. Delaying care can also let small problems progress, and regular exams help find conditions that may need attention.

FAQ

What does "use it or lose it" mean for dental benefits?

It means benefits that go unused by the end of the benefit year may expire. The unused part of your annual maximum typically does not carry into the next year.

Does my dental plan year end on December 31?

Not always. Many plans use a calendar year, but others use a plan year that varies by group. Check your insurance card, portal or HR.

Do unused dental benefits roll over?

Typically no, but plan rules vary. Confirm with your insurer.

Does my deductible reset too?

Deductibles generally apply for a set period and start over when coverage renews. Your plan documents list the exact terms.

Can I use my benefits on a cleaning in late December?

It may be possible, but appointments fill up near the end of the year, and your plan sets its own rules. Book as early as you can and confirm your coverage with your insurer.

How do I find out what benefits I have left?

Check your insurer's portal or plan documents, or call your insurer. The dental office can also give you a breakdown before treatment.

Is an FSA the same as dental insurance?

No. An FSA is an account funded by your pay. Its year-end rules come from your employer's plan.