Use Your Dental Insurance Before It Resets: A Year-End Guide
November 8, 2026 · By Dr. Nadia Rodriguez, DMD · No Limits Dental, Midtown Manhattan · Leer en español
If your dental insurance runs on the calendar year, any benefits you don’t use by December 31 are usually gone. Your annual maximum, the most your plan will pay each year, typically doesn’t roll over, and your deductible starts over in January. Booking your care before the year ends lets you use the coverage you’ve already paid for.
What Resets on January 1?
For most PPO plans that follow the calendar year:
- Your annual maximum. Many plans pay up to a set amount each year, such as $2,000. Whatever you don’t use this year usually doesn’t carry over.
- Your deductible. The amount you pay before your insurance starts contributing starts over.
- Your cleanings and exams. Many PPO plans cover two cleanings and exams a year. If you haven’t had both, the second one is often available until December 31. Some plans allow two cleanings per calendar year, while others require about six months between them.
Some plans run on a different 12-month cycle. If you’re not sure, our team can check your plan for you, including how much of your annual maximum you have left.
What Should I Book Before the Year Ends?
- Your cleaning and exam, if you haven’t used both visits this year.
- Treatment I’ve already recommended, such as a filling, a crown or a broken tooth repair. A small cavity is simpler to treat now than after it grows.
- The first phase of a larger treatment plan, so your insurance contributes this year and again next year.
Already met your deductible? If you’ve paid your deductible this year, treatment you complete before the year ends won’t require paying it again. In January, it starts over.
How Much Will My Insurance Pay?
Every plan is different, but many PPO plans are set up in three levels: preventive care such as cleanings and exams is often covered at or near 100%, basic care such as fillings often at around 80%, and major care such as crowns often at around 50%, all up to your annual maximum. Before treatment, we check your plan and tell you what your insurance will contribute and how much of your annual maximum is left.
Does Insurance Cover Cosmetic Dentistry?
Treatment that is only cosmetic, such as teeth whitening, usually isn’t covered. But when a tooth needs to be restored because of decay or a break, insurance often contributes, even when the result also looks beautiful. A retired detective’s insurance covered part of his 20 porcelain crowns because he had cavities and broken teeth. Read his story.
How to Split Treatment Across Two Benefit Years
If you need several crowns or a larger restoration, we can plan it in phases, so part is done this year and part after your benefits renew in January. That way, your insurance can contribute its annual maximum twice instead of once.
One of my patients needed crowns because of decay. Her insurance contributed its $2,000 annual maximum, and we completed her treatment around November, so her benefits renewed in time for her cleanings in January. Read Maria’s story.
Do You Have an FSA or HSA?
You can use your FSA or HSA for eligible dental treatment at our office, and we’ll provide the documents you need for reimbursement. FSA funds often have a year-end deadline, so check your plan’s date. Unused FSA money may be lost.
Starting a Crown in December?
At our office, a crown is billed when the final crown is placed, not when the tooth is prepared. A crown that is prepared in December but placed in January is billed to January’s benefits. Crowns usually take about two to three weeks from preparation to placement, so if you want to use this year’s benefits, start early enough for your crown to be placed by Wednesday, December 30.
Switching Dental Insurance in January?
If you’re changing jobs or plans, use your current benefits before that coverage ends. Some new plans have a waiting period before they cover major treatment such as crowns, so check your new plan’s details. Once you have your new member ID, our team can check your benefits.
How We Help You Use Your Benefits
Before treatment, we check your benefits and give you a clear estimate of what your insurance will contribute. All three of our dentists accept most major PPO plans, including Aetna PPO, Blue Cross Blue Shield, Cigna, Delta Dental Premier, GEHA, Guardian, Lincoln Financial Group, MetLife, Principal, Sun Life Financial, United Concordia and UnitedHealthcare. If your plan isn’t listed, you can still use your out-of-network benefits with us. See the PPO plans we accept.
No dental insurance? Ask about our direct dental membership plan, which includes two cleanings a year.
Schedule On Time: Our Holiday Closures
December gets busy as patients use their benefits, so it’s important to schedule on time. Our office is closed on:
- Thanksgiving, November 26, and the day after, November 27
- Christmas Eve and Christmas Day, December 24 and 25
- New Year’s Eve and New Year’s Day, December 31 and January 1
That makes Wednesday, December 30 our last day open in 2026. Se habla español.
