Menu
Call Us: (405) 329.6603
Menu
Ah, December. The most wonderful time of the year. Time for decking halls, dashing through the snow, and…discussing your dental benefits.
Whether you have traditional dental insurance or a Flexible Spending Account (FSA) to help pay for dental expenses, chances are your benefits are on a deadline, and most deadlines are December 31. While some plans may end at different times throughout the year or follow a “rolling calendar,” where benefits roll over into the next year, most insurance plans—both dental and general healthcare—operate on a traditional calendar schedule and reset every year on January 1.
So what does this mean for you?
Depending on your plan, it may mean leaving money and valuable coverage on the table.
There are two primary types of dental plans with benefits that expire every year.
The first is a dental benefits plan through your employer. This is usually a group plan like a Preferred Provider Organization (PPO) that requires a monthly premium, which may be paid entirely by the employer, entirely by the employee, or a combination of both. Employees are then typically responsible for a deductible and a copayment when they seek dental care, but will pay lower out-of-pocket costs if they visit an in-network provider.
The second is a Flexible Spending Account, or FSA. FSAs are set up through your employer and use pre-tax dollars from your paycheck to cover eligible healthcare and dental expenses. During open enrollment each year, you’ll decide how much money to put into the account for the year, and a portion of that will be deducted before tax from each of your paychecks, though most FSAs have a maximum amount you can contribute each year. It will work sort of like a checking account, where you can use an FSA debit card to pay for your medical and dental expenses.
Both types of plans have an annual maximum they will cover in dental care.
The first is a dental benefits plan through your employer. This is usually a group plan like a Preferred Provider Organization (PPO) that requires a monthly premium, which may be paid entirely by the employer, entirely by the employee, or a combination of both. Employees are then typically responsible for a deductible and a copayment when they seek dental care, but will pay lower out-of-pocket costs if they visit an in-network provider.
The second is a Flexible Spending Account, or FSA. FSAs are set up through your employer and use pre-tax dollars from your paycheck to cover eligible healthcare and dental expenses. During open enrollment each year, you’ll decide how much money to put into the account for the year, and a portion of that will be deducted before tax from each of your paychecks, though most FSAs have a maximum amount you can contribute each year. It will work sort of like a checking account, where you can use an FSA debit card to pay for your medical and dental expenses.
Both types of plans have an annual maximum they will cover in dental care.
1) Your deductible resets. Your deductible is the amount of money you have to pay to your dentist out-of-pocket before the insurance kicks in to cover any services. The fees vary from one plan to another and can be higher if you see a dentist who is out of your plan’s network, but the average deductible is about $50. Once you meet this amount in payments to your dentist, the insurance company will pay a percentage—or in some cases all—of specified care and treatments through the end of the year. On January 1, for many plans, your deductible resets and you start the year back at the beginning.
2) Any unused benefits are lost. If you are paying a premium every month for your insurance plan, you are accruing benefits to help you cover the cost of many dental-related expenses and routine care. Dental benefits typically cover the majority of preventative and restorative procedures like fillings, crowns, implants, bridges, x-rays, and more, while some plans even cover some or all of the cost of dentures, implants, or oral surgery. For most dental insurance and FSA plans, the benefits provided are “use or lose”; if you don’t use them by the end of the year, you lose what you’ve paid for and you start right back at square one for the next year.
Changes in coverage. The healthcare and insurance world is a fickle and fluid one; there is no guarantee that your benefits remain the same every year.
Fee increases. Some dentists raise their rates at the beginning of the new year to account for increases in costs of living, materials, and equipment, which could translate to higher fees and co-pays for you.
Your covered benefits will depend on your plan, but in general, most FSAs and dental insurance plans will cover all or at least a portion of the cost of preventative and restorative treatments, services, and procedures including:
Some plans will even cover the cost of oral pain remedies, co-pays, and deductibles, but few—if any—will cover premiums or cosmetic services like whitening, veneers, or cosmetic orthodontics.
To maximize your dental benefits, you first need to find out some important information such as:
If you have employer-provided dental benefits or an individual plan, such as those available through Health Insurance Marketplaces:
Take advantage of any benefits before they expire, including preventative care like bi-annual cleanings and checkups, for which most plans pay nearly 100%. If you haven’t had an exam yet this year, now’s the time to do it.
Use your coverage early. During earlier checkups and exams, talk to your dentist about what treatments you may need before the end of the year as well as what’s covered. Schedule them as soon as possible to make sure you get as much coverage as possible.
If you’ve already met your deductible and need a routine cleaning or restorative procedure like a filling, do it now while the insurance company will pay for at least a portion of it, if not all of it.
If you have an FSA:
Plan carefully. Don’t plan to put more money into your account than you’ll spend in a year. Before open enrollment, talk to your dentist about what kinds of services you may need and how much you’ll need to budget for them.
Contact your FSA administrator. Your FSA administrator can provide information on your plan allowances as well as a list of covered services and products, referred to as “eligible expenses.”
Make any appointments as soon as you know you’ll need them. This helps ensure you use your FSA dollars in time.
Ask your employer about extensions to use your funds. Employers may offer a grace period of up to 2.5 extra months after December 31 to use your money, or they may allow you to carry over a certain amount per year into the following year.
No matter which type of plan you have, there’s an added advantage to using all your benefits before they expire on the dental treatment you know you need. The majority of dental conditions do not go away on their own, only worsening with time; what’s a cavity today will only become a root canal tomorrow if it isn’t treated. By taking care of problems now, you can use what you have left to pay for important treatment and avoid more expensive and extensive procedures in the future that you may not have all the coverage to pay for. Sometimes your dentist can even split a procedure into phases or stages, so you can have some work done at the end of the year and delay the rest until the next year when your benefits reset.
Missed your window to use your dental insurance or FSA benefits? Don’t worry. Now’s a great time to talk with your dentist to start planning for next year. You may also still have time to take advantage of the open enrollment period, which happens near the end of every calendar year and gives you a chance to make changes to your current plan and benefits, or even change plans.
According to the National Association of Dental Plans, roughly 97% of people with PPO dental plans reach or exceed the annual maximum for their plans each year. That’s hundreds of dollars that can be used toward preventative and restorative dental care that ensures a lifetime of good oral health.
If you want more information on getting the most out of your end-of-year dental benefits, call Norman Smile Center today and schedule an appointment. We do everything we can to make paying for essential dental care easy and affordable, including submitting insurance claims on your behalf. We accept most major dental insurances and we’re a preferred provider for Blue Cross-Blue Shield, Cigna, and Delta Dental. We also offer an array of payment and financing options to complement your insurance coverage and fit any budget. Don’t wait until it’s too late; start using your benefits today!