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Use It or Lose It: What Your Dental Insurance Will Cover

October 3, 2020

Filed under: Uncategorized — boylesdentistry @ 3:34 pm
A young woman sitting in the dentist’s chair and smiling

When it comes to using your dental insurance, do you know what it covers? The reality is that most people do not know the ins and outs of the insurance world, which is why dental offices throughout the country employ individuals who can assist in not only helping you better understand your coverage but also maximizing your benefits before they expire. Read on to learn more about the details of your insurance and what you can do to keep more money in your pocket.

Dental Insurance: How It Works

There are a few important things to know when it comes to better understanding how dental insurance works.

  1. You are expected to pay a monthly premium to gain access to your benefits.
  2. Most dental insurance plans are based on a 100-80-50 style of coverage. This means an estimated 100% of the cost for preventive care is covered, 80% for basic restorative services, and 50% for major restorative care.
  3. You have a deductible you must meet before your insurance will “kick in,” however, it is typically much smaller ($50-$100) than what you would find in your medical insurance plan. You also receive an annual maximum, which is typically around $1,500. This is provided to you by your insurer to use throughout one calendar year. Once it runs out, you are responsible for any remaining out of pocket expenses.
  4. Your dental benefits do not roll over year-to-year. At midnight on December 31, they expire.

What Your Insurance Covers

Since most plans are covered at 100-80-50, you can expect your preventive services (i.e. checkups and cleanings, X-Rays) to cost you little to nothing at all. Dental insurance companies design their plans to encourage patients to be proactive about their oral health to avoid costly problems in the future. However, should you require a dental filling, they are prepared to cover anywhere from 70-80% of the cost, and more complex restorative services (i.e. dental crown, bridge) are covered at 50-70% of the total cost.

How to Maximize Your Benefits

There are three things you should do to ensure you do not let more money fall into the hands of your insurance company at the end of the year. These include:

  • Scheduling your second dental checkup. Many insurance companies are waiving their “six months and one day” policy this year because of COVID-19, allowing you to see your dentist a second time even if your first appointment was only one month ago.
  • Seeking complex treatment now. If you need a root canal, this will ensure you use your annual maximum, preventing any remaining balance from being returned to the insurance company on December 31.
  • Seeing an in-network dentist. This crucial step will keep more money in your pocket each time you visit. Out-of-network providers can still provide coverage, but you will end up paying more for the services you receive.

If navigating your dental insurance policy seems overwhelming, let a member of your dental team offer their assistance. This will ensure you maintain a healthy smile and have more money to splurge on your favorite family members this holiday season.

About the Author
At Boyles General Dentistry, our team of dental professionals believes in providing a superior approach to treatment. Offering preventive services to help you maintain a healthy smile and avoid future dental problems, we will go above and beyond to ensure your teeth and gums are decay- and disease-free each time you visit. We will also help you maximize your dental insurance benefits to avoid losing valuable money at the end of each year. If you’re ready to learn what you can do to get the most out of your plan, visit our website or call (432) 366-0896.

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