A new dental or vision carrier on January 1, 33 new state laws, and the December 31 reset
The 2027 plan year got its enrollment dates and its first prices while two large programs switch dental and vision carriers on Jan. 1 — this issue prices what a switch moves, what one crown costs on either side of the December 31 reset, and what to ask before booking.
The last week of September is when the next plan year stops being a guess. Between Sept. 21 and Sept. 28 the federal dental and vision program got its enrollment window, two large programs named the carriers they will add and drop on Jan. 1, and a third put a price on 2027: 12.5% more for dental and 7.5% more for vision 12.
The documents that would let you compare those new plans are not out yet. As of Sept. 22 the 2027 plan details were not posted on BENEFEDS, the site where federal enrollees shop and enroll 1. OPM publishes its plans, premiums and coverage for the coming year during Open Season, which opens Nov. 9 3.
The other end of the calendar is already fixed. Both federal dental plans count their limits by calendar year — Delta Dental caps adult cleanings at two in a calendar year, and MetLife describes a calendar-year deductible — so a maximum reached this year starts over on Jan. 1, and what is left unspent does not follow you into January 45.
What this week set
The federal enrollment window is Nov. 9 to Dec. 7. FEDVIP Open Season for 2027 runs Nov. 9 through Dec. 7, 2026, with enrollment changes effective Jan. 1, 2027. Medicare's Open Enrollment runs Oct. 15 to Dec. 7, and TRICARE's Nov. 9 to Dec. 8 1.
The state-level reform count passed 400 laws. The American Dental Association reported Sept. 22 that 18 states have enacted 33 new dental insurance laws this year, on top of more than 100 reform bills introduced across 37 states in the 2026 legislative season. Laws on assignment of benefits, virtual credit cards and provider network leasing have passed in more than half the states 6.
One large program put 2027 prices on the record. The State of Texas Dental Choice Plan's premiums will rise 12.5% for all participants in the 2027 plan year, and the state's vision plan will rise 7.5%, ERS said on Sept. 22. The agency credited the dental increase to network expansion and the vision increase to greater use of benefits and rising vision costs 2.
Two programs named new carriers for January. CalPERS, whose open enrollment runs Sept. 14 to Oct. 9, will offer state employees and retirees new dental plans from Delta Dental and MetLife starting Jan. 1, 2027, alongside six PPO options and two prepaid plans for employees. Three dental plans end on Jan. 1 — Western Dental, Premier Access and the MetLife Enhanced DHMO — and a member who chooses nothing is automatically enrolled in MetLife Select DHMO 7. In Hawaii, HMSA Vision, powered by EyeMed, replaces VSP as the vision carrier for EUTF members on Jan. 1, 2027 and for HSTA VB members on July 1, 2027; members enrolled in the VSP plan are moved into the new plan automatically. That switch also replaces a VSP-specific diabetic eye care program with the incoming carrier's version 8.
The federal program's own 2026 averages were republished. Average enrollee premiums in FEDVIP rose 3.35% for dental and 0.47% for vision in 2026, across 21 dental and 10 vision options 3.
Two of those items are market facts, and two are facts about specific plans. Only the second kind changes a bill, and for most readers the one to look for in their own open-enrollment packet is the carrier switch.
What a carrier switch moves
Three things decide what you pay for a cleaning, a crown or a pair of glasses: your employer's or program's plan design, the carrier's network and fee schedule, and what your dentist or optometrist charges. When the carrier changes on Jan. 1, the middle layer is replaced whole. The percentage your plan quotes may look identical and still leave a different bill, because every number underneath it is new.
Five terms carry most of that bill, and each one means one specific thing:
- Allowance — a fixed amount the plan puts toward a purchase. EyeMed's own example: with a $100 frame allowance on a $150 frame, you pay the $50 difference 9.
- Annual maximum — the most the plan pays for covered services in the plan year. MetLife's brochure states it plainly: once you reach that amount, you are responsible for all additional charges 5.
- Member share, or coinsurance — your percentage of the plan's allowance, not of the price on the wall 4.
- In-network and out-of-network — in network, your share is a percentage of a negotiated allowance and you are not responsible for charges above it. Out of network, you also owe the difference between the plan's allowance and what the practice bills 5.
- Predetermination, or pre-treatment estimate — the plan's written answer before treatment, naming the allowed amount, the deductible and your share 4.
The trap in a switch is that inaction also has a result. CalPERS members who do not select a dental plan during the open enrollment now running will be enrolled in MetLife Select DHMO, a prepaid plan type that CalPERS lists separately from its PPO options 7. Hawaii's VSP members are transferred into the incoming plan automatically, without a decision 8. If you have a dentist or an optometrist you intend to keep, the first question in either case is whether that provider is in the new plan's network.
The same dental year under Delta Dental and MetLife
Both carriers now run dental plans for CalPERS, so both will appear in a lot of open-enrollment packets this fall. Their 2026 federal plans are built the same way — the same class structure, the same in-network preventive coverage — and priced differently.
| 2026 federal dental option | Delta Dental High | Delta Dental Standard | MetLife High | MetLife Standard |
|---|---|---|---|---|
| In-network member share, Class B / Class C | 30% / 50% 4 | 45% / 65% 4 | 30% / 50% 5 | 45% / 65% 5 |
| In-network annual maximum | Unlimited 4 | $1,500 4 | Unlimited 5 | $2,000, in and out of network combined 5 |
| In-network deductible | $0 4 | $0 4 | $0 5 | $0 5 |
| Waiting period for major services | None 10 | None 10 | None 10 | None 10 |
| Adult cleanings (D1110) | 2 per calendar year 4 | 2 per calendar year 4 | 2 in 12 months 5 | 2 in 12 months 5 |
| Scaling and root planing (D4341, D4342) | Once per quadrant in 24 months 4 | Once per quadrant in 24 months 4 | Once every 24 months 5 | Once every 24 months 5 |
| Self-only monthly premium, rating area 1 | $39.67 4 | $22.38 4 | $40.76 5 | $23.60 5 |
Reading across, the two carriers agree on almost everything a routine year touches. The differences sit in two places a switch would move.
The first is the ceiling. On the Standard options, Delta Dental pays up to $1,500 of in-network care a year and MetLife up to $2,000, and MetLife counts out-of-network spending against that same $2,000 45.
The second is the clock the cleaning limit runs on. Delta Dental counts adult cleanings per calendar year; MetLife counts two in any 12 months 45. Under the calendar-year count, a cleaning in the last week of December and one in the first week of January land in two different years and both are covered. Under the 12-month count, that same pair is your two, and the next one has to wait until the first of them drops out of the window.
MetLife's 2026 federal plan also shows how a benefit can get narrower without the headline percentage moving. Its list of changes effective Jan. 1, 2026 includes replacement fillings going from no limit to once in 24 months, occlusal guards from once in 12 months to once in 24 months, and general anesthesia moving from a Class B service to a Class C service — the class where the member share rises from 30% or 45% to 50% or 65% 5.
The same vision year under VSP and MetLife
Vision is where a carrier switch is easiest to see, because the whole benefit is an allowance table. VSP and MetLife are two of the five vision carriers in the federal program, and both publish their terms in full 10.
| 2026 federal vision option | VSP High | VSP Standard | MetLife High | MetLife Standard |
|---|---|---|---|---|
| Eye exam | $0 at Premier Edge, $10 elsewhere in network 11 | $0 at Premier Edge, $10 elsewhere in network 11 | $0, one per calendar year 12 | $0, one per calendar year 12 |
| Frame allowance, Featured Frame Brands | $250 11 | $200 11 | $250 12 | $190, plus a $20 copay 12 |
| Frame allowance, other brands | $200 11 | $150 11 | $200 12 | $150, plus a $20 copay 12 |
| Frame allowance at Costco, Walmart or Sam's Club | $200 11 | $150 11 | $200 12 | $85, plus a $20 copay 12 |
| Contacts instead of eyeglasses | $150 11 | $120 11 | $150 12 | $120 12 |
| Contact lens fitting and evaluation | Up to $55 11 | Up to $55 11 | Up to $55 12 | Up to $55 12 |
| Out-of-network reimbursement, exam / frames | VSP directs members to Member Services 11 | VSP directs members to Member Services 11 | Up to $45 / up to $70 12 | Up to $45 / up to $70 12 |
| Laser vision correction | 15% average savings at participating locations 12 | 15% average savings at participating locations 12 | 15% average savings at participating locations 12 | 15% average savings at participating locations 12 |
| Self-only monthly premium | $14.56 11 | $7.76 11 | $11.98 13 | $7.95 13 |
The laser row is a test of the same habit: MetLife's discount is a discount, available only at participating locations, and it is not an allowance you can spend 12. EyeMed describes its LASIK benefit the same way, as a discount through a US Laser Network provider 9.
On the High options, the two carriers pay the same amounts on every field a member usually asks about: a $0 exam copay, a $250 allowance on featured frame brands, $200 on other frames, $150 for contacts, up to $55 for the fitting. A switch between the two High options is close to a wash on benefits, which leaves the $2.58 monthly difference in premium, the network each carrier has built in your area, and one further field the table shows. MetLife prints its out-of-network reimbursement as fixed dollar amounts, while VSP's federal brochure sends members to Member Services for theirs 1112.
The Standard options are where they part. At a warehouse club — Costco, Walmart or Sam's Club — VSP pays its $150 standard allowance, while MetLife's Standard option pays $85 and adds a $20 copay. Frames from a standard brand get the same $150 allowance under both, with MetLife's $20 copay on top 1112. Where you buy is a field in the plan, and it is worth reading as one.
So when a switch letter names a new vision carrier, the request that answers this is one sentence long: send the allowance table and the frequency rules for the new plan. The carrier's brand tells you which stores and laboratories the plan is built around. Only the plan document tells you what your frames are worth.
One crown and three dates
Take a porcelain crown at the national average of $1,399, on Delta Dental's Standard option — a 65% member share for major services, a $1,500 in-network annual maximum, and a self-only premium of $268.56 a year at rating area 1 414.
| The same $1,399 crown, on Delta Dental Standard | The plan pays | You pay |
|---|---|---|
| December 2026, with maximum left | $489.65, inside the $1,500 ceiling | $909.35 |
| December 2026, with the maximum already spent | $0 | the practice's contracted in-network fee for the crown |
| January 2027, after the reset | up to $489.65 again | about $909.35, at the 2026 terms |
Two details sit under that table. With an in-network dentist, an exhausted maximum puts you on the practice's contracted fee rather than its billed charge, because the agreement caps what it can collect from you; out of network, the difference between the plan's allowance and the bill is added to your side 5. And the January figure is the 2026 one, because the 2027 premium and terms for the same plan are not published yet 1.
The same arithmetic explains when the higher option earns its premium. On the High option, the crown year is $476.04 in premium plus $699.50 of a crown — $1,175.54 — against $1,177.91 on Standard, a difference of about $2 4. In a year with one major restoration, the two options land in the same place. In a year with cleanings and nothing else, Class A services carry a 0% in-network share, so the premium is the whole difference: $207.48 4. Which option wins depends on the year you expect, and only you have that.
What the same work costs in cash
Cash prices are the fallback when a maximum runs out, a frequency limit refuses a visit, or the network has no one nearby. These are national averages and ranges, useful for screening a quote rather than confirming one:
- Routine dental exam with a full cleaning and X-rays: $203 average, ranging $50 to $350 14.
- Composite resin filling: $226; silver amalgam: $139 14.
- Porcelain crown: $1,399; porcelain fused to metal: $1,114; metallic: $1,211 14.
- Molar root canal: $1,337, inside a national range that runs $679 to $1,733 1415.
- Periodontal maintenance cleaning: $167; scaling and root planing: $242 per quadrant 14.
- Bitewing X-rays: $65; full-mouth X-rays: $226 14.
- Uninsured ranges at a private practice: cleaning and exam $75 to $200, filling $50 to $450, root canal $700 to $1,500, crown $800 to $2,500 or more 16. Dental school teaching clinics treat patients at lower fees than private practices, under faculty supervision 16.
- Basic eye exam without insurance: $79 to $110 at warehouse clubs, where the optometrist is an independent doctor and a membership is not required; a contact lens exam and fitting runs $125 to $150; private optometrists run $95 to $250 17.
What patients and offices reported this week
On Sept. 24, a member posting in r/DentalInsurance described a first year with dental coverage, a PPO for two people, and a husband who arrived at a third visit of the year with a broken tooth. The exam and X-rays came back denied against the plan's two-appointments-per-person limit, leaving a balance of about $600; the member wrote that the next eligible exam was a year away and the next X-rays two years away 18. Replies from other members and from office staff suggested the same order of operations: pull the plan's frequency limits for the exam and for the X-rays separately, wait for the practice's invoice rather than the explanation of benefits, ask the insurer about a reconsideration or a goodwill exception if the visit was close to the eligibility date, and ask the practice about prompt-pay or hardship terms before paying the full balance 18. One reply made the point that matters most for the number: an in-network practice must still submit the claim, and its contracted fee usually applies whether or not the service is covered 18. That is one member's account of one claim.
Two office-side threads the same week point at the machinery behind the bill. On Sept. 24, a private practice wrote that several carriers it holds separate contracts with are processing its claims on a leased "Connection Dental" fee schedule, which the practice said runs significantly below its direct contracts; replies described asking the leased network to stop sharing the agreement with specific payers, and noted that a payer can use the lowest fee schedule available to it 19. On Sept. 23, another office said one carrier required electronic funds transfer enrollment as a condition of credentialing, and that the payment files arrive across several portals 20. These are office reports about their own contracts rather than statements of carrier policy, and they bear on the practices the ADA's count addresses, where network leasing laws have passed in more than half the states 6.
What to do in the next three months
- Count what is left of the 2026 maximum, and ask the insurer for the exact figure rather than estimating from your own receipts. Both carriers count these limits by calendar year, so the balance is gone on Jan. 1 45.
- Get the number in writing before the appointment. Both federal dental plans provide a predetermination or pre-treatment estimate, and one recommends it for charges over $300 5.
- If your carrier changes on Jan. 1, ask the new plan for its allowance table and frequency rules before you book. The old plan's numbers stop applying on Dec. 31.
- Find out what happens if you choose nothing. Some programs enroll non-choosers by default, and at least one is placing them in a prepaid plan type that sits separately from its PPO options 7.
- Ask two questions at the billing desk. "What is the contracted allowed amount for this procedure code at my in-network rate?" and "If my maximum is used up, what would you charge a cash patient for this, and will you put that in writing?" The second question is the one that turns a denied claim into a negotiable number 18.
- If a claim is denied on frequency, ask for the plan's written rule for that code and its reconsideration route. Denials on exam and cleaning frequency are answered with the plan document's own wording, which is also what an appeal has to quote 18.
The one number still missing is next year's. The federal program's 2027 plan details were not posted when its enrollment window was announced, and OPM publishes them during Open Season, from Nov. 9 to Dec. 7 13. Until then, the pieces that are fixed are the dates, this year's remaining maximum, and the state protections on assignment of benefits, virtual credit cards and network leasing that more than half the states now have on the books — and those are protections you can ask about by name in a billing conversation today 6.
References
- 1
- 2Understanding your 2027 premiums
ers.texas.gov
- 3
- 4
- 52026 The MetLife Federal Dental Plan
fedvip.metlife.com
- 6400 laws and counting: dental advocacy is driving change
adanews.ada.org
- 7Open Enrollment for Active Members
calpers.ca.gov
- 8ERS Holomua, Fall 2026
ers.ehawaii.gov
- 9EyeMed Vision Benefits FAQ
eyemed.com
- 10Dental and Vision, BENEFEDS
benefeds.gov
- 11VSP
federal.vsp.com
- 12MetLife
fedvip.metlife.com
- 13MetLife Federal Vision rates
fedvip.metlife.com
- 14Dentist Prices: Dental Procedure Cost List
carecredit.com
- 15Root Canal Cost and Procedure Guide
carecredit.com
- 16Access Lower-Cost Dental Care
penndentalmedicine.org
- 17Costco Eye Exam Cost With and Without Insurance
costcoguides.com
- 18Dental claim denied - what do I do?
reddit.com
- 19Connection Dental Fee Schedule
reddit.com
- 20
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