You probably know that your dental insurance is important, but do you know how it works? Studies estimate that less than 3% of PPO dental plan members use all the benefits they’re paying for every year, which could be thousands of dollars’ worth per family. Thankfully, even though dental insurance can seem confusing at times, understanding some of the basics can help you save a significant amount of money while caring for your smile. Read on as we share five practical and important tips for understanding how dental insurance works.
1.) Know What Expenses You’ll Be Responsible for
While dental insurance can help cover many of the costs of your oral healthcare, don’t forget that there are several expenses you’ll be responsible for as well, like:
- Co-payments: Most plans include a co-pay, which is a flat fee you’ll need to pay every time you visit your dentist for an appointment.
- Coinsurance: Your coinsurance outlines what amount (usually a percentage) you’ll need to pay for specific treatments. For instance, if your plan says you have 20% coinsurance on fillings, your insurance will pay for 80% of your treatment and you’ll be billed the remaining 20%.
- Premium: This fee is typically paid every month, quarter, or year to keep your coverage active (like a subscription fee for a streaming service).
2.) Keep in Mind What Your Annual Maximum and Deductible Are
Your annual maximum is the dollar amount that your dental insurance company is willing to pay for your dental care. However, before your insurance will start to cover your costs, you need to meet your deductible. This is the amount you need to pay out-of-pocket for your own treatments before your insurance coverage kicks in. In most cases, plans with lower deductibles also have lower annual maximums, while higher deductibles usually mean higher maximums.
3.) Understand the 100-80-50 Coverage Structure
While every insurance policy is different, most follow a similar structure of coverage where they’ll pay:
- 90-100% of preventive care costs, like checkups, cleanings, diagnostics, and screenings.
- 70-80% of basic treatments, such as fillings or gum disease treatment.
- 40-50% of major procedure expenses, including root canals and custom dental crowns.
4.) Remember that Your Benefits Likely Don’t Roll Over
Before your coverage period ends (typically at the end of the calendar year), see how much is left of your deductible or annual maximum. Most of the time, any unused benefits will expire when your plan renews. If you need dental work and haven’t met your maximum by the end of the year, it’s a good idea to schedule your treatment before January. Otherwise, you’ll need to pay for much more (if not all) of your treatment to meet your deductible again.
5.) Don’t Be Afraid to Ask Your Dentist for Help
With so many different types of plans, terms, and exclusions, there is still a lot to learn about dental insurance. If you’re feeling confused or unsure about how your dental benefits work, talk to your dentist! They have plenty of experience dealing with dental insurance, and they can help you make the most out of your coverage.
About the Practice
Maxwello Dental and Orthodontics aims to provide compassionate, high-quality dentistry for all the smiles of Pearland, Houston, and the surrounding communities. Not only are they in-network with some of the most popular insurance carriers, but they are happy to accept out-of-network policies as well. They’ll handle the paperwork, file your claims on your behalf, and ensure your coverage is maximized to make the entire experience as pleasant as possible. For patients without dental insurance or who aren’t happy with their coverage, they also offer third-party financing options through CareCredit. To see just how affordable caring for your smile can be, don’t hesitate to contact them via their website or at (713) 436-2522.