Dental insurance plans are unique and sometimes confusing! Each policy offers slightly different benefits. It’s important to connect with an experienced dentist who accepts your insurance and whose office staff can help you maximize dental services based on your available benefits.
It’s important to note that dental benefits typically expire every year. While some plans run from August 1 through July 31, most will run from January through December. Paying attention to your available benefits can save you money and improve your oral health.
Here are five reasons to use your insurance benefits each year. Don’t let those benefits go to waste!
1. Tap into Minimal or Even Zero Out-of-Pocket Expenses on Cleanings and Checkups
Different dental policies offer additional benefits. Some dental insurance plans pay 100% of preventative dental care, like exams, professional teeth cleaning, and x-rays, with a maximum of $1,000 to $2,000 annually.
Most patients can see their dentist every six months and not even come close to the maximum amount payable for preventive dental care. In these cases, the insurance company would pay for x-rays, exams, and cleanings with no out-of-pocket costs for the patient.
When patients do not visit a dentist during the calendar year, they lose out on zero-cost preventive care and risk experiencing costly dental issues like cavities or gum disease. Patients often underestimate the value of nearly-free preventive care, which is an expensive mistake. Every six months, you should get the most out of your dental insurance with consistent cleanings and checkups.
2. Dental Coverage for Cleanings and Checkups Greatly Reduces Costly Dental Care
When patients get consistent preventative care, they visit their dentist every six months and the dentist can catch minor concerns before they become severe and expensive to treat. This saves patients money.
Dental plans also have an allotted amount of money set aside for dental procedures each calendar year. Cleanings and checkups can keep the teeth and gums healthy and reduce the risk of future dental problems.
When a person has an existing dental problem that isn’t quite ready for treatment, preventive visits can slow the progression of these problems. Regular checkups can buy valuable time to plan and save for future treatment in order to get the most out of dental insurance. When patients delay bi-annual dental visits, they delay a potential diagnosis, which could cause them to miss out on benefits.
Regularly visiting the dentist ensures that you will get a cleaning before your benefits expire, allowing you to utilize all available benefits. For example, the dentist will watch certain teeth and keep an eye on gum measurements, help maintain older fillings, and correlate future procedures with dental benefits to reduce out-of-pocket costs.
3. Maximize Benefits to Cover a Treatment Plan
Patients who need more than just annual dental checkups and cleanings should schedule an appointment as soon as possible to collect as many dental benefits during the calendar year as possible. Once the dentist diagnoses a dental problem, they will discuss treatment options and work out a treatment plan designed to make the most of dental insurance benefits before they expire.
When a complex treatment plan is needed, the dentist can use the dental plan for specific procedures, crowns, dentures, and more, by scheduling some work for the current calendar year and additional work for the following year.
You should see a dentist early in the calendar year to ensure you have ample time to have each procedure done during the current year and enjoy the benefits available. For example, if you need to have a root canal, plus other dental work, you will need to have a regular checkup, then see a specialist before returning to the dentist to have additional work like an older crown removed and replaced.
4. Double Your Benefits
Beginning your dental treatment before the year ends, allows you to receive double benefits! Benefits typically renew at the beginning of January and patients needing more than routine dental work can utilize benefits at the end of the year. They are able to max out on benefits in December and start all over again in the new year.
The dental office experts can help the patient receive the highest dollar amount from the insurance company to minimize out-of-pocket costs. Doubling up on benefits by continuing a treatment plan during the consecutive year is a strategic way to have a dental plan paid for through insurance benefits.
5. Possible Increases in Dental Costs and Premiums
Patients pay premiums each month, and another important reason to use dental benefits each year is the possible price increase of dental procedures, monthly premiums, deductibles, and copays. Each year, the cost of copays and premiums can increase.
You should take advantage of yearly dental benefits to the fullest extent possible. Each time you or your family member on a family plan visits the dentist, the office submits a claim to the insurance. The insurance company pays the claim and subtracts the cost of service from the maximum allowable amount.
When the plan reaches the maximum allowable payment for dental care, the patient is responsible for out-of-pocket costs. Unspent benefits within the maximum amount are not carried into the following year. At the start of the next benefit year, an equal maximum amount is allotted.
Some plans are flexible to accommodate tight budgets. Still, it’s always a good idea to visit the dentist regularly and be upfront about staying in the dental annual maximum. The dental office knows how to spread out-of-pocket costs to help the patient meet their needs.
Review the Policy
The first step to maximizing dental insurance benefits is to understand your policy. Each policy offers different coverage, limitations, and costs. There are many kinds of dental insurance plans, including Dental PPO (DPPO), Dental EPO (DEPO), DHMO (DHMO), and Dental POS (DPOS).
Different types of insurance coverage include:
- Basic restorative care
Basic restorative care typically includes extractions, fillings, and non-routine x-rays.
- Preventive dental care
Preventative dental care often includes regular teeth cleaning, fluoride treatments or sealants, routine x-rays, and more as indicated by age and frequency.
- Orthodontic treatment
Orthodontic care can include braces, space maintainers, and other treatments to align the teeth.
- Major restorative care
Major restorative coverage can include bridges, dentures, and crowns.
Dental Insurance Vocabulary
A deductible is paid out-of-pocket before the plan begins to pay. Some dental plans, such as DPPO, have deductibles, while others do not.
- Annual Maximum
Each plan has a maximum that they agree to pay towards dental care during one year. If patients go over this amount, they are responsible for those out-of-pocket costs.
Premiums are paid monthly toward medical plans. Some plans tend to be higher in cost than others. DHMOs tend to have lower premiums, but they are more limited in their coverage and annual maximum.
Coinsurance is the percentage of the treatment cost that the patient shares, once the deductible is met. If a plan does not have a deductible, the patient pays a flat fee toward any services they receive.
Important Insurance Coverage Questions
Patients should review their dental policy to determine the following factors:
When does the year begin and end?
As stated earlier, most dental plans offer yearly benefits from December through January. However, some insurance plans expire on July 31, and patients need to know when their insurance plan year begins and ends to maximize the program’s benefits.
Is there a delay on some coverage?
Preventative care typically covers the patient right away, but insurance plans may require patients to wait a certain amount of time before having complex or more costly dental care.
While some dental plans do not have a waiting period, most policies postpone paying for certain types of care to prevent covering pre-existing issues. For example, patients may need to wait after requesting insurance before getting a crown, root canal, or implants.
Are more costly procedures covered, like bridges, root canals, and implants, as well as preventative care?
Dental work can get expensive, and there are some essential procedures that people often put off because of poor insurance coverage. Dental insurance covers preventive care and some more costly procedures like implants, bridges, and dentures. Patients need to review their dental insurance before they receive a diagnosis or experience pain and discomfort.
What is the maximum dollar amount of benefits provided through the plan?
Dental insurance premiums are typically much lower than medical insurance premiums, but dental insurance offers a different coverage structure.
Dental plans may cover 80% of extractions, fillings, and root canals. However, they may only cover as much as 50% of the cost of gum disease treatment, bridges, crowns, implants, and dentures. Patients need to review their dental policies each year and take advantage of the available benefits.
Schedule a Checkup and Ask About Your Insurance Coverage
If you have postponed routine maintenance and bi-yearly checkups, call 713-960-9623 or visit Uptown Dentistry to schedule an exam, routine x-rays, and a cleaning. Uptown Cosmetic and Implant Dentistry is located in Houston, TX. We prioritize the needs of each patient and are ready to help you maximize the benefits available through your insurance policy.