Your dental insurance benefits typically reset on January 1st, which means unused benefits from this year disappear completely. Understanding how to maximize these benefits before December 31st can save you hundreds or even thousands of dollars on necessary dental care. Most dental insurance plans include annual maximums, deductibles, and coverage limits that refresh with the new year, making the end of the year an ideal time to complete treatments you’ve been postponing.
Many people don’t realize the value they’re leaving on the table by not using their full insurance benefits. Taking advantage of what you’ve already paid for through premiums makes financial sense and helps you maintain better oral health.
How Dental Insurance Works
Most dental insurance plans operate on a calendar year basis, running from January 1st through December 31st. Your plan likely includes an annual maximum, which is the total amount your insurance will pay for dental care in a single year. Common annual maximums range from $1,000 to $2,000, though this varies by plan.
You also have a deductible, the amount you must pay out of pocket before your insurance begins covering services. Many plans have separate deductibles for individuals and families. Once you meet your deductible, your insurance kicks in to cover a percentage of costs based on the type of service.
Preventive care like cleanings and exams typically receives 100% coverage. Basic procedures such as fillings usually get 70% to 80% coverage, while major procedures like crowns or bridges often receive 50% coverage. These percentages depend on your specific plan details.
Why Year-End Planning Matters
If you’ve already met your deductible this year, scheduling additional treatments before December 31st means you won’t have to pay another deductible in January. This can save you $50 to $150 right away. Similarly, if you’ve used some but not all of your annual maximum, the remaining benefits will disappear on January 1st.
Waiting until next year to complete treatment means starting over with a new deductible and a reset annual maximum. For example, if you need a crown that costs $1,200 and your insurance covers 50%, you could receive $600 in coverage. But if you wait until January, you’ll first need to meet your new deductible before receiving any coverage.
Many people need dental work that spans multiple appointments. Starting treatment now allows you to split costs between two benefit years, potentially doubling your coverage. You might receive work in December covered by this year’s benefits, then complete the treatment in January using next year’s benefits.
Common Benefits People Forget to Use
Many plans include specific benefits that people overlook. Most insurance covers two preventive cleanings per year at 100%. If you’ve only had one cleaning this year, schedule your second appointment before December 31st to take full advantage of this benefit.
Fluoride treatments are often covered for children and sometimes for adults at high risk for cavities. X-rays typically receive full coverage once per year, with some plans covering bitewing x-rays twice annually. These diagnostic tools help catch problems early when they’re easier and less expensive to treat.
Some plans also cover dental sealants for children and teens, which protect teeth from cavities. Night guards for teeth grinding may receive partial coverage under certain plans. Check your specific benefits to see what preventive services you haven’t used yet.
Steps to Maximize Your Benefits
Contact your insurance company or check your online portal to review your current benefits status. Find out how much of your annual maximum you’ve used, whether you’ve met your deductible, and what coverage remains for the year. This information helps you plan which treatments to prioritize.
Schedule a comprehensive exam at JAX Dental Studio to identify any dental needs. Dr. Poblenz can create a treatment plan that considers both your oral health needs and your insurance benefits. Some treatments can wait, while others require immediate attention.
Ask your dental office for a breakdown of costs and insurance coverage before proceeding with treatment. This allows you to understand your out-of-pocket expenses and make informed decisions about timing. Your dental team can coordinate with your insurance to verify benefits and provide accurate estimates.
Important Considerations for Treatment Planning
Not all dental work needs to happen before year-end. Focus on addressing problems that could worsen if left untreated, such as cavities, gum disease, or damaged teeth. Preventive and necessary restorative work should take priority over purely cosmetic procedures.
Consider these factors when deciding which treatments to schedule:
- Urgency of the problem: Tooth pain, infections, or damaged restorations need immediate attention regardless of timing, as delaying treatment often leads to more complex and expensive procedures later.
- Available coverage: Prioritize procedures with higher coverage percentages to maximize your insurance benefits, especially if you’ve already met your deductible for the year.
- Financial impact: Calculate your total out-of-pocket costs for completing treatment now versus waiting until January, factoring in both deductibles and remaining annual maximum benefits.
- Treatment complexity: Some procedures require multiple appointments, so starting complex work now might allow you to spread costs across two benefit years.
- Schedule availability: Dental offices experience higher demand in November and December as more people try to use year-end benefits, so book appointments early to secure preferred times.
Understanding these factors helps you create a strategic treatment plan that aligns with both your health needs and financial situation.
In-Network vs. Out-of-Network Benefits
JAX Dental Studio works with major insurance carriers including BlueCross BlueShield, Humana, Cigna, Florida Combined Life, and Aetna. Being in-network typically means lower out-of-pocket costs because the practice has agreed to specific fee schedules with these insurers.
Out-of-network benefits still provide coverage, but you may pay higher fees or receive lower reimbursement percentages. Many plans offer out-of-network benefits that still help reduce your costs significantly. The team at JAX Dental Studio can verify your specific coverage and explain your benefits regardless of your network status.
Understanding the difference between in-network and out-of-network benefits helps you make informed decisions about where to receive care and what to expect for costs.
Alternative Financing Options
If insurance doesn’t cover all your dental needs, JAX Dental Studio offers additional payment options. The practice provides financing through Cherry and other payment plans that help make dental care affordable. These options allow you to spread costs over time with manageable monthly payments.
The practice also offers a membership plan for patients without insurance. This program provides preventive care and discounts on other treatments for an annual fee, often saving members significant money compared to paying out of pocket for each service.
Take Action at JAX Dental Studio
December approaches quickly, and dental offices fill their schedules as patients rush to use remaining benefits. Dr. Poblenz and the team at JAX Dental Studio can help you understand your coverage and create a treatment plan that maximizes your insurance benefits while addressing your oral health needs. The practice goes above and beyond to help patients understand and use their benefits effectively, making quality dental care accessible and affordable. Contact the office today to schedule an appointment and review your benefits before year-end.
