If you have dental insurance, there’s something important you need to know: most dental benefits expire on December 31st. That means any coverage you haven’t used this year will disappear and you’ll have to start over in January.
At Upper West Side Dental, we’re already seeing December appointments fill up fast. If you’ve been putting off dental work or haven’t scheduled your second cleaning of the year, now is the time to act. Here’s everything you need to know about maximizing your remaining 2025 dental benefits before they’re gone.
How Dental Insurance Actually Works
Before we dive into why year-end matters, let’s quickly break down how most dental insurance plans work. Understanding these basics will help you see exactly what’s at stake.
Annual Maximum
Your annual maximum is the total amount your insurance company will pay for dental care in a calendar year. Most plans set this between $1,000 and $2,000. Once you hit that limit, you’re responsible for 100% of any additional costs. But here’s the catch: if you don’t use it, you lose it. Unused benefits don’t roll over to the next year.
Deductible
Your deductible is the amount you pay out of pocket before your insurance starts covering costs. This typically ranges from $25 to $100 per person. Once you’ve met your deductible for the year, your insurance kicks in at higher coverage rates. But on January 1st, that deductible resets—meaning you’ll have to pay it all over again.
Coverage Tiers
Most dental plans use a tiered coverage structure:
- Preventive Care (100% covered): Routine cleanings, exams, and X-rays. Most plans cover two cleanings per year at no cost to you.
- Basic Procedures (70-80% covered): Fillings, extractions, and periodontal treatments. You pay the remaining 20-30%.
- Major Procedures (50% covered): Crowns, bridges, root canals, and dentures. You’re responsible for half the cost.
Understanding these tiers helps you plan strategically—especially when you’re trying to maximize benefits before year-end.
The Problem: Use It or Lose It
Most dental insurance plans operate on a calendar year. This means your annual maximum—the total amount your insurance will pay for dental care—resets every January 1st. If you haven’t reached your maximum by December 31st, that unused coverage doesn’t roll over. It simply vanishes.
Think about it this way: your dental benefits are part of your compensation, whether you pay for them directly or they’re provided by your employer. Not using them is like leaving part of your paycheck on the table.
The same goes for your deductible. If you’ve already paid your deductible this year, you’re in a great position to get more work done at a lower out-of-pocket cost. But come January, you’ll need to pay that deductible all over again before your insurance kicks in.
What You’re Losing: The Real Numbers
Most dental plans offer an annual maximum between $1,000 and $2,000. If you’ve only used a portion of that—or none at all—you’re leaving real money on the table. Let’s look at what typically goes unused:
- Preventive care: Cleanings, exams, and X-rays are usually covered at 100%. Many plans allow two cleanings per year—have you had both?
- Basic procedures: Fillings and extractions are typically covered at 70–80%.
- Major procedures: Crowns, bridges, and root canals are often covered at 50%.
Real Cost Examples
Here’s how the numbers break down for common dental procedures:
Dental Crown
- Average cost: $1,200
- With insurance (50% coverage): You pay $600
- Without insurance/after benefits expire: You pay $1,200
Your savings: $600
Root Canal + Crown
- Average cost: $2,000
- With insurance (50% coverage): You pay $1,000
- Without insurance: You pay $2,000
Your savings: $1,000
Two Fillings
- Average cost: $400
- With insurance (80% coverage): You pay $80
- Without insurance: You pay $400
Your savings: $320
Even if you need treatment that spans two calendar years, starting now means you can maximize this year’s benefits and use next year’s for the remaining balance.
What Happens If You Wait Until January?
Procrastination can be costly when it comes to dental care. Here’s what you’re facing if you wait until the new year:
Your Deductible Resets
If you’ve already met your 2025 deductible, any treatment you get now costs less out of pocket. Wait until January, and you’ll have to pay that deductible again before insurance coverage kicks in. That’s an extra $50-$100 (or more) coming straight out of your wallet.
Dental Problems Get Worse
That small cavity you’ve been ignoring? It won’t stay small. Dental problems almost always get worse—and more expensive—over time. A $150 filling today could become a $1,200 crown in six months. A minor gum infection could progress to periodontal disease requiring extensive treatment.
You Lose This Year’s Benefits Forever
Let’s be clear: unused 2025 benefits are gone on January 1st. There’s no way to get them back. If you have $800 remaining in your annual maximum, that $800 disappears at midnight on December 31st.
January Is Just as Busy
Many people think they’ll “get to it” in January when things calm down after the holidays. But January brings its own rush of patients who made New Year’s resolutions about their health. Plus, you’ll be competing with everyone else who waited too long in December. The best time to book is now.
What You Should Do Now
Don’t wait until the last week of December to think about your dental health. Here’s how to make the most of your remaining 2025 benefits:
- Schedule your preventive visit: If you haven’t had your second cleaning this year, book it now. Preventive care helps catch small problems before they become big (and expensive) ones. Plus, it’s usually covered at 100%.
- Address that nagging issue: Have a tooth that’s been bothering you? A filling you’ve been putting off? Sensitivity that won’t go away? Now is the time to take care of it while you still have coverage available.
- Start larger treatments: If you need a crown, bridge, or other major work, beginning the process now lets you split the cost across two benefit years. You can use your remaining 2025 benefits for the first phase and tap into your fresh 2026 benefits for completion.
- Get emergency care covered: Experiencing pain, swelling, or a dental emergency? Your insurance can help cover urgent treatment—but only if you act before your benefits expire.
- Plan for next year: Use your end-of-year visit to discuss any upcoming treatment needs with Dr. Shirley. We can help you create a plan that maximizes your benefits across both years.
Don’t Forget Your FSA and HSA Funds
If you have a Flexible Spending Account (FSA) or Health Savings Account (HSA), you may have additional funds available for dental care.
FSA Funds: Use Them or Lose Them
Most FSA accounts operate on a “use it or lose it” basis. While some employers offer a grace period or allow you to roll over a small amount, many FSA funds expire on December 31st. Dental care is an FSA-eligible expense, making it a smart way to use remaining funds.
HSA Funds: More Flexibility, But Why Wait?
HSA funds don’t expire and roll over year to year. However, if you have dental work you need done anyway, using your HSA now—while your insurance benefits are still active—means you’re combining two sources of savings. Your HSA can cover your copays and deductibles, while your insurance handles the bulk of the cost.
Double Your Savings
Here’s a smart strategy: Use your dental insurance benefits to cover the maximum amount, then pay your remaining out-of-pocket costs with FSA or HSA funds. This way, you’re using pre-tax dollars for everything your insurance doesn’t cover.
Act Fast: December Fills Up Quickly
Every year, we see a surge of patients in December trying to use their benefits before the deadline. Appointment slots become limited, and the closer we get to the end of the month, the harder it is to find availability.
The best thing you can do is call now. Our team at Upper West Side Dental will verify your insurance benefits and help you understand exactly what’s covered—so you can make informed decisions about your care.
We’re also happy to help you strategize. If you need extensive work, we can help you plan treatment across multiple visits to maximize your benefits in both 2025 and 2026.
Tips for Maximizing Your Dental Benefits Year-Round
While you’re thinking about your dental benefits, here are some tips to help you get the most value throughout the year:
- Schedule both cleanings early: Book your first cleaning in January or February and your second in June or July. This ensures you never miss a preventive visit and spaces them out properly.
- Don’t delay treatment: When Dr. Shirley recommends treatment, schedule it promptly. Waiting only allows problems to worsen and costs to increase.
- Know your benefits: Take a few minutes to understand your plan’s annual maximum, deductible, and coverage percentages. This helps you make informed decisions about timing and treatment.
- Plan major work strategically: If you need expensive treatment, consider timing it at the end of one benefit year and beginning of the next to use two annual maximums.
- Keep us informed: If your insurance changes, let us know right away. We’ll verify your new benefits and update your file so there are no surprises.
Frequently Asked Questions
When should I book my December appointment?
NOW. December is our busiest month and slots are filling fast. Don’t wait until mid-December when availability is extremely limited. Call (917) 261-7555 to secure your appointment.
Can I use my benefits even if I haven’t been to the dentist all year?
Yes! Your 2025 benefits are available until December 31st, regardless of whether you’ve visited the dentist this year. We can help you maximize your remaining coverage with a comprehensive exam, cleaning, and any necessary treatment.
What if I need more work than my benefits will cover?
We can help you prioritize treatment and create a plan that spans two benefit years. By starting treatment in December and completing it in January, you can potentially use two annual maximums—doubling your available coverage.
Can I split treatment between two benefit years?
Absolutely. This is actually a smart strategy for major work. For example, if you need two crowns, we might do one in December (using 2025 benefits) and one in January (using 2026 benefits). This way, you maximize coverage for both.
What’s the difference between in-network and out-of-network?
When you visit an in-network dentist like Upper West Side Dental, you benefit from pre-negotiated rates with your insurance company. This typically means lower out-of-pocket costs and no surprise bills. Out-of-network dentists haven’t agreed to these rates, so you may pay significantly more.
I have FSA/HSA funds expiring too—can I use those?
Yes! Dental care is an eligible expense for both FSA and HSA accounts. You can use these funds to cover copays, deductibles, and any treatment not fully covered by insurance. If your FSA funds expire at year-end, dental care is a great way to use them.
What if I don’t know what my benefits are?
No problem. Just bring your insurance card or give us your member ID, and we’ll verify your coverage for you. We’ll explain exactly what’s covered and what your out-of-pocket costs will be before any treatment begins.
Do you accept my insurance?
Upper West Side Dental is in-network with most major dental insurance plans, including Delta Dental, Cigna, Aetna, Guardian, MetLife, and many others. Call us at (917) 261-7555 to confirm your specific plan.
Don’t Wait—Book Your Appointment Today
Your dental benefits are a valuable part of your overall compensation. Whether they come through your employer or a plan you purchased yourself, not using them is like throwing money away.
Whether you need a routine cleaning, have been putting off treatment, or are experiencing a dental emergency, now is the time to act. Our team is ready to help you understand your benefits, prioritize your treatment, and make the most of your coverage before December 31st.
📞 Call (917) 261-7555 to schedule your appointment
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Upper West Side Dental has been proudly serving the Upper West Side, Morningside Heights, and Harlem communities since 2011. Dr. Benjamin Shirley and our team are committed to helping every patient achieve optimal oral health—and that includes making the most of your dental benefits. We look forward to helping you end the year with a healthy smile.