Why am I paying full price after my dental plan resets?

You may be paying more after your dental plan resets because your deductible starts over with the new benefit year. Until you meet that deductible, you may have to pay more for services your plan does not fully cover upfront. Your annual maximum also resets, but your copays, coinsurance and other plan rules still determine how much you owe. 

What you will learn in this article: 

• Your dental bill may be higher after a plan reset because you may have to meet a new deductible. 

• Your annual maximum resets too, but copays, coinsurance and other plan rules still affect what you pay. 

• Some cleanings and exams may not require a deductible, so your cost depends on the details of your plan. 

• Knowing your benefit-year dates and asking for a pretreatment estimate can help you plan care and avoid surprises. 

If you’re unsure what your dental plan reset means for your costs, schedule an appointment with an Aspen Dental provider. Your care team can help you understand your benefits and what you may pay before treatment

What "reset" actually means 

Your dental plan covers care during a set benefit period. According to the American Dental Association (ADA), most plans use either a January-to-December calendar or another benefit period set by the plan group. A new deductible starts when coverage renews, and the annual limit applies to that benefit period.¹ 

When a new benefit period begins, your plan starts counting the deductible and annual limit again. This does not mean the plan now covers more services or pays a larger share.

The deductible is the first thing you feel 

The ADA describes a deductible as the amount you cover before your plan begins paying eligible costs. At the start of a new benefit period, you may need to meet that amount again.¹ If your deductible is $100, you may have to pay toward that $100 even if you met it last year. Some cleanings and exams may be covered without a deductible, so check your plan. 

This is one reason your first bill may be higher. You may owe more for services that count toward the deductible until you meet it. 

The annual maximum resets too 

Your annual maximum is the most your plan will pay toward covered care during one benefit year. Any costs above that amount are generally your responsibility to pay out of pocket. The ADA notes that, in most cases, benefits left at year’s end do not carry forward.² When the new benefit year begins, you have a new annual maximum to use, but you may still owe a deductible, copay or coinsurance. 

Calendar year vs. plan year 

Not every dental plan starts over in January, so it helps to know exactly when yours resets. Some use another benefit schedule set by the plan. Check your plan document or call your insurer for the exact start and end dates. Knowing these dates can help you understand when your deductible and annual maximum start over. 

What about waiting periods? 

Resets aren't the only timing rule to watch for. Some dental plans also make you wait a set amount of time before certain services are covered. The ADA lists waiting periods as one type of plan limit that may change what is covered.³ Ask your insurer whether your plan has a waiting period, which services it affects and when it ends. Do not assume it follows the same schedule as your deductible or annual maximum. 

Your dental office may also help you check what your plan covers now. 

How to plan smarter around a reset 

Here are a few things worth thinking about as the benefit year moves forward. 

Know when your year ends 

Check your plan document or ask your dental office or insurer for the exact end date. If you have met your deductible and still have benefits left, ask what covered care can be completed before the benefit year ends. Your share may be lower, but the amount depends on your plan. 

Don't let your maximum go to waste 

Many plans end any benefits you have left when the benefit year closes. Some plans handle rollover differently, so check your plan document before you schedule care. Work with your dental provider to plan needed treatment based on your oral health and coverage. 

After the reset, budget for the deductible 

Once you've met your new deductible, your plan may pay part of the covered cost based on your copay, coinsurance and other plan rules. Ask your dental office how much of a planned treatment will count toward your deductible before you schedule it. 

Ask your dental office for a cost estimate 

Ask your dental office for a pretreatment estimate before planned care. The ADA says the office sends the treatment plan to the insurer for review. The reply may show which services are covered, what the plan expects to pay, your deductible, your copay and your annual maximum.³ This can give you a clearer idea of your share before treatment. 

Before scheduling planned treatment, ask your dental care team for a cost estimate and check where you stand with your deductible and annual maximum. That can give you a clearer idea of what your plan may cover and what you may owe. 

Why am I paying full price after my plan resets? FAQs 

Still have questions about dental plan resets and what you may owe? These answers cover a few common concerns. 

Why did my plan reset if I never changed it? 

Your plan resets on the schedule in its contract, even if you did not change coverage. The benefit year may follow the calendar or another period set by the plan. Check your plan documents or call your insurer for the exact date. 

Can my dental office check when my plan resets? 

Your dental office may be able to check your benefit dates, remaining deductible and annual maximum. You can also confirm these details in your plan documents or by calling your insurer. Ask for a benefits check before planned care so you can better understand what your plan may pay. 

Can I split a big treatment across two plan years to save money? 

Sometimes, yes. If a treatment can be done in stages, scheduling part before your plan year ends and part after the reset can let you use two years of maximum coverage. Talk with your dental office about timing. They can help you map out a treatment plan that works with your benefit calendar. 

What if I can't afford my deductible right now? 

Ask your dental office about payment options. Many offices offer payment plans or financing for patients who need care but face a high upfront cost. Your dental provider wants you to get the care you need, and there may be more options than you expect. 

Sources 

¹ American Dental Association, MouthHealthy: “Choosing the Right Dental Plan for You.” https://www.mouthhealthy.org/dental-care/choosing-the-right-dental-plan-for-you 

² American Dental Association, MouthHealthy: “Your Dental Benefits: Use Them or Lose Them.” https://www.mouthhealthy.org/dental-care/using-dental-benefits 

³ American Dental Association: “Glossary of Dental Terms.” https://www.ada.org/publications/cdt/glossary-dental-terms