When Do My Health, Dental and Vision Benefits Reset?

It depends on the benefit, and sometimes on the carrier. Your medical deductible may reset on January 1 or on your company's plan anniversary. Most dental benefits reset on the calendar year. Vision benefits usually run on a rolling 12 months from your last visit. Knowing which is which can save you money, especially in the last few months of the year.

These are some of the most common questions our clients' employees ask us, so here's how each one works.

When does my medical deductible reset?

Your deductible is the amount you pay for covered care before your plan starts paying its share. Once a new benefit year starts, your deductible and out-of-pocket maximum go back to zero.

When that happens depends on your carrier. Priority Health resets deductibles on your plan anniversary, which is the month your employer's plan renews. If your company renews on July 1, your deductible resets July 1, not January 1. Priority Health does offer employers a calendar-year deductible option, so check your plan documents or ask us if you're not sure which one you have. Most other carriers we work with reset deductibles and out-of-pocket accumulators on a calendar-year basis, on January 1, regardless of when your employer's plan renews.

Why it matters: if you've already met your deductible, or you're close, the time before it resets is a good window to schedule procedures, tests or follow-up care you've been putting off.

Do my dental benefits reset on the calendar year?

Yes, for the dental plans we see most often. Your annual maximum, the most your plan will pay toward your care in a year, resets on January 1, along with any dental deductible. Unused dental benefits don't carry over. If you have treatment your dentist has recommended, like a crown or a filling, scheduling it before December 31 lets you use this year's maximum instead of starting next year's.

My vision plan says glasses every 12 months. Is that per calendar year?

No. It's a rolling 12 months from the date you last used the benefit. If you picked up new glasses on March 10 this year, you're eligible again on or after March 10 next year, not on January 1. Some plans also cover frames on a different schedule than lenses, for example lenses every 12 months and frames every 24. Check your date of last service with your eye doctor or your vision carrier before you order.

What about my FSA?

If your employer offers a health flexible spending account, pay close attention to its deadline. FSAs are generally "use it or lose it." Some plans let you carry over a limited amount into the next year, up to $680 of unused 2026 funds, while others give you a short grace period instead. Your employer decides which option applies. An HSA is different: that money is yours and rolls over year to year.

Questions about your benefits?

If you're an employee on a plan we manage, or an employer in the Muskegon area reviewing your group benefits, we're happy to help. Call Steve at (231) 798-0073 or email steve@lebmi.com.