Dental insurance yearly maximum and rollover

The yearly maximum, also called the annual maximum or annual max, is the most a dental plan pays toward one patient's care in a plan year. Once the plan has paid that much, the patient pays the rest of the year's care in full, whatever the coverage percentages say. For a quote, what matters is the maximum left, not the plan's total.

When it starts over

The maximum starts over at the start of each plan year. That is January 1 on a calendar-year plan, and the plan's own renewal date on a benefit-year plan. The plan summary says which. Unused money usually doesn't carry over: on most plans, what isn't used by the end of the year is gone. The deductible usually starts over on the same day; the verification checklist has the plan year as its own step.

Rollover, on the plans that have it

Some plans carry part of an unused maximum into the next year. Insurers call it a rollover, carryover or maximum accumulation. The rules differ by plan, but the ones we read follow the same pattern. Sources: Delta Dental of Arkansas, Carryover benefits explained and Beam Benefits, Do dental benefits roll over?, both read November 13, 2026.

• The patient has to be seen. Plans usually require at least one covered visit in the year, such as a cleaning or an exam.
• Claims have to stay low. The plan's payments for the year must stay under a set amount, such as less than half the maximum.
• Only part rolls over. Beam's example adds one fourth of the maximum: a $1,000 maximum with $200 used carries $250 into next year. Delta Dental of Arkansas's example carries up to $625 a year on a $2,500 maximum.
• The bank has a ceiling. The total carried over stops growing at a cap the plan sets.
• It can be lost. A move to another group plan or a break in coverage can reset the balance to zero.

A rollover balance often shows on the benefits page as its own line, next to the yearly maximum. Check whether the portal's maximum left already includes it before you quote.

Before quoting big work

1. Find the yearly maximum and how much is used so far, as of today. Claims still being processed may not show yet.
2. Check the plan year: calendar year, or a benefit year with its own start date.
3. Look for a rollover or carryover balance, and whether it's already in the maximum left.
4. Work the estimate line by line in the order the work will be billed. Once the maximum runs out, later lines are the patient's.
5. If the maximum runs out partway, tell the patient before treatment. Some patients choose to split elective work across two plan years; urgent care shouldn't wait for the plan.

How Tabruns uses it

Tabruns reads the yearly maximum and how much is used from the benefits page when the page shows them, and stops insurance paying once the maximum left runs out. A note under the estimate says The yearly maximum runs out with this treatment when it does. The arithmetic is in how to calculate a dental patient portion. If the page can't be read, or the number came from a phone call, type it in Yearly max left; see when the page can't be read.

For other limits that change the number, see waiting periods, frequency limitations and the missing tooth clause.