Your dental coverage resets at the beginning of each new calendar year. In other words, if you don’t use up your dental benefits by December 31st, you miss out on them forever. Now is the perfect time to make the most of your dental coverage. However,
What is the Difference Between Dental Plans and Dental Insurance?
Many of us are familiar with these dental coverages but unaware of how they differ significantly in their benefits and cost structure.
Dental insurance works like traditional health insurance. Your employer usually provides coverage through their group plan at a discounted rate. Once you match the deductible, the insurer covers all or part of your dental costs, depending on the policy. Some plans require you to pay the entire bill upfront and then seek payment from the provider. Others have no out-of-pocket expense until after you fulfill the deductible.
Dental discount plans are similar to dental insurance except that there are no deductibles, no annual maximums, and no waiting periods. They usually offer discounts ranging from 10 to 60 percent off standard rates. However, they aren’t to replace regular dental coverage. Most dental discount plans require members to have some regular dental coverage already. Most dental discount plans charge yearly membership fees between $100 and up. If you know you’ll need extensive dental care, the dental discount plan may be worth considering. Otherwise, regular dental insurance may provide better benefits.
What Does Dental Insurance Cover?
Preventive care is covered by most health insurance policies but not all. Preventative care may be limited to checkups, cleanings, and minor repairs such as fillings. Cosmetic procedures like teeth whitening or implantation are not included or covered in a typical plan.
While full coverage doesn’t front the entire procedure cost, they do cover a wider range of services like wisdom tooth removal, root canal therapy, crowns, dental implants, Invisalign, and more. Check with your insurer to make sure you have adequate coverage.
Dental Insurance Options – DHMOs vs. PPOs vs. Referral Dental Plan
PPOs (Preferred Provider Organizations) and DHMOs (Dental Health Maintenance Organizations) are two types of health insurance plans available through employers. Both offer benefits similar to those offered by traditional medical insurance companies, including coverage for preventive care services, prescription drugs, hospitalization, and emergency room visits. However, there are some differences between these two types of plans.
DHMOs are usually cheaper than PPOs because they cover fewer services and typically require members to pay out-of-pocket for certain procedures. On the other hand, PPOs often cover a broader range of treatments not found in DHMOs. These are cosmetic solutions such as veneers, dental implants, clear aligners, braces, etc.
Companies that offer discounted dental plans typically contract with a network of dental professionals. Contractually, these dentists provide discounted fees for most treatments. The contracts themselves do not cover any cost. The approved dentist within your company’s network directly charges you for the treatment needed at a lesser fee.
Which is the Best Type of Dental Coverage?
It depends. There isn’t one type of dental insurance that is best for everyone. It’s important to consider what you want and need before choosing a dental plan. For example, if preventative care is all you require, then the DHMO might be best suited. But if you need comprehensive coverage, it may be wise to look into a PPO.
If you’re someone in need of a more extensive set of procedures, then a referral dental plan may be right for you. These plans allow patients to choose their providers, which means they can get the care they need without worrying about finding a provider who will accept their insurance.
Renewal: Where Do Your Benefits Go?
Your annual maximum is the total amount your dental insurance company will pay out toward your dental care during one year. When your dental claims are processed, your insurance provider deducts this amount from your account. Any remaining balance must be paid by you.
Your annual maximum applies to the dental expenses covered by your health insurance plan. Dental deductibles and copayments count toward your annual maximum limit. However, certain types of treatments may not count toward your annual limit. For example, routine dental services like x-rays, preventative care, and cleanings are a few. This depends on the specifics of your dental plan, so check with your provider.
Dental plans typically have annual limits that cap how much coverage you get for certain procedures. In most cases, after these limits are reached, you’ll be responsible for covering the rest of the cost once the year is up.
In most cases, you cannot carry over any unused coverage from one year to the next. This means you must use all of your available benefits by December 31st. Keeping track of your benefits and scheduling appointments is essential because you never know when you might be able to use them again.
While many Americans don’t realize that their policy has limits, those who do often find themselves nearing the end of their yearly allotment. To maximize your coverage, call your insurer to verify your current status. Another method is to look up your policy online.
If you’ve used up all of your benefits, it might be wise to wait until next year to undergo any major procedures. However, if funds are still available, schedule an appointment now to avoid paying out of pocket.
One of the most effective ways to minimize costs associated with dental care is to schedule multiple procedures at once. Scheduling several visits during a single year means you won’t have to spend as much out-of-pocket at the end of the year. Talk to your dentist about scheduling appointments a few months ahead of time to take advantage of your coverage.
What Factors Can Affect Your Dental Benefits Coverage?
Dental benefits change yearly, depending on your enrollment in employer-sponsored health care. Your dental benefits coverage may be affected by several factors, including age, gender, income level, employer type, and location.
The most important factor affecting your dental benefits coverage is your age. Generally speaking, younger individuals pay lower premiums than older individuals because they’re healthier.
However, there are exceptions to this rule. For example, young adults who work for large companies often receive discounts on their dental benefits due to company policies. Likewise, those who qualify for government subsidies through Medicaid or Medicare may not need to purchase private health insurance.
Another factor that affects your dental benefits coverage is whether you live in a rural or urban area. Rural areas tend to offer fewer dental benefits than urban areas. This is because many dentists practice in urban areas where patients are more likely to seek treatment.
Finally, your dental benefits coverage may depend on your employer type. Large employers typically offer better dental benefits than small businesses.
Staying on Top of Receiving Dental Treatment
As mentioned above, staying on top of receiving dental treatment is crucial to maximizing your coverage. If you have a gap in your insurance coverage and need to pay out-of-pocket for dental care, you may be able to get reimbursed come tax season.
You should also make sure that you keep track of your dental expenses throughout the year. You can use receipts to determine how much you spent on dental treatments each month. Then, when filing taxes, you can deduct these expenses from your taxable income.
In addition to keeping track of your dental expenses, you’ll want to stay informed about new dental benefits offered by your provider. Many providers will send information about upcoming changes to their dental benefits coverage through email.
If you’re seeking high-quality dental care within the Houston, TX, area, consider choosing Uptown Cosmetic & Implant Dentistry. Our professionals work with you to achieve the best results possible. We provide preventative dentistry, as well as cosmetic treatments to those seeking to restore their smile.