If you have dental insurance through your employer, you probably have access to a guaranteed set of treatments you’re allowed to use in a given year. However, if you don’t use those benefits, it’s extremely unlikely that they will be available to you come the new year. That’s why dentists all over are encouraging and helping patients make the most of their benefits before January 1st, 2020, the most common day for benefits to reset. If you find yourself asking “how do dental benefits work?”, you’ll want to keep reading.
Important Facts About Dental Insurance
While it may be surprising to hear, most individuals with a PPO dental plan will not maximize the funds they allotted towards that plan. For example, every plan comes with an annual maximum, which refers to the amount of money that an insurance company will pay for services. On average, annual maximums reach $1,250. However, only 2.8 percent of people with PPO dental plan participants reached or exceeded their annual maximum, according to the National Association of Dental Plans.
What’s even more surprising is that the average American with dental insurance only receives $323 worth of dental treatment in a given year, which means the average American is losing $927 per year in unused benefits. The most important thing is that you make use of your benefits now, before they reset in the new year.
How Insurance Works and What It Covers
Generally, dental insurance covers care via a 100%/80%/50% coverage model. Broken down, this refers to preventive/minor restorative/major restorative care respectively. While every dental plan has its own details that require additional examination, you can expect most dental plans to cover care in this way.
Preventive care mainly refers to exams, cleanings, X-rays, and in some cases fluoride therapy to strengthen enamel. Minor restorative care includes tooth-colored fillings and sometimes root canal therapy, while major restorative care refers to crowns, bridges, and dentures.
Unfortunately, many aspects of your insurance can change once the year is up, including premiums, co-pays, annual maximums, and deductibles, so you’ll want to take advantage of them now before they do.
How to Maximize Your Benefits
Start by speaking with your dentist directly as well as their treatment coordinator/insurance specialist if they have one. From there, they can help you create a plan that maximizes treatments you need while you still have your insurance’s benefits. While this may include basic treatments like cleanings and exams, it may also include more complex options like dental crowns or tooth replacements. These can easily extend into the next year, but using benefits now ensures that you aren’t affected by changes in your insurance coverage in the new year since you’ve already started treatment.
Are you looking for ways to make the most of your dental insurance? Don’t let them go to waste; call your dentist today to get started!
About the Author
Dr. John E. Petty works hard to help patients get the most out of their dental insurance coverage, especially towards the end of the year. His team will calculate how much you’ll pay for treatment in advance so you can plan accordingly and never be met with surprises. They’ll gladly submit claims on your behalf and handle the entire process from start to finish. To get started, call his office today!