Dental Blog

Don’t Lose Your Dental Benefits This Year

Tuesday, July 2, 2019

Many adults find it easy to take their dental health for granted. Unfortunately, this can backfire not only because it can result in serious health conditions, but it can also negatively impact you financially. Did you know that less than half of insured adults actually use their dental benefits even though about 47% of adults participate in employer-sponsored dental insurance plans according to a 2019 survey by the National Association of Dental Plans? And when they don’t use the benefit (like nearly half of those who are insured), they lose it. Only 4.2% of those insured actually reach their annual maximum. So, instead of leaving money on the table and wasting the money you put into the plan (the average annual cost of dental insurance is about $360 per person per year), here’s some information you need to know about dental insurance and dental benefit plans so you can get the most out of your investment.

What to know about dental insurance.

Health insurance is confusing and expensive. This reality causes many of us to just avoid the details of our plans altogether but doing so only harms us. One of the best ways to be sure you are maximizing your insurance is to gain a better understanding of what it covers and your options. Dental insurance also has nuances that are different than how other insurance works, so it’s good to understand what those are.

Dental benefits versus insurance.

Other insurance types like homeowners and car insurance are set up to cover a loss and the insurer carries the risk. If you lose your home to a natural disaster or fire, your homeowner’s policy will pay you the value of your home. Same goes for your vehicles if they are totaled; full coverage car insurance policies will pay you the value of your car. Dental coverage is set up as a benefit plan and as such will only cover certain charges up to an annual maximum. For example, free preventative care (exams, cleanings, and X-rays), $1,500 to $2,000 annually for restorative procedures (fillings, crowns, etc.) and a $1,500 to $ 2,000-lifetime benefit for orthodontics are typical annual maximums. It’s even possible that some procedures recommended by your dentist won’t be covered at all by your dental benefits plan.

The majority of dental plans operate on a calendar year; what you don’t use by December 31, you lose. Since dental insurance deductibles are often under $100, people don’t act with a similar urgency to fitting in services before the end of the year as they do for higher-deductible healthcare plans.

Dental insurance coverage.

Dental benefits are designed around annual maximum benefits rather than a cost-of-care model. Therefore, while preventative care (two dental exams and two cleanings per year) is often covered, other services aren’t covered at 100%.. When you sign up for dental insurance, be sure to understand what is covered by your benefits and what you will be responsible for. Here are some of insurance terms you might encounter:

  • Deductibles: What you will need to pay before your plan pays anything. Typically, there is no deductible to meet when you get preventative or diagnostic services but be sure to verify what your plan covers.
  • Coinsurance: Coinsurance is the percentage of the charges that you are responsible for paying. For example, a 70/30 plan would mean your benefits provider would handle 70% of the charges for a service and you would pay the remaining 30%.
  • Annual maximums: This is the limit that your plan will pay each year. If the services you received reached $4,000 in a year, but your plan’s annual maximum is $2,000, you would have to pay the $2,000 out of pocket.
  • Least expensive alternative treatment (LEAT): This is a clause in some plans that states if there is more than one option for treatment, the plan will cover the least expensive service.
  • Pre-existing conditions: Know how pre-existing conditions are defined and handled by your dental benefits plan.
  • Treatment plans: Dental benefits plans often require you or your provider to submit a treatment plan for prior authorization before any services are completed. If you have any concern that a procedure might not be covered, it’s always a good idea to run it by your plan’s administrator who will review the treatment proposal, determine the patient’s eligibility for the procedure, the co-payment that will be required, and the max amount to be covered.

Kinds of dental plans.

From acronyms such as PPO to DHMO and fears that you are making the wrong decisions about dental coverage, it can be stressful to pick out a plan. Here are some of the most common types of dental plans.

  • Preferred Provider Organization (PPO): As it means with health insurance, if you are part of a PPO dental plan, you must go to an in-network provider to receive your full benefit. If you receive care outside the network the services might only be partially covered or not covered at all. In-network providers agreed to the PPO’s established fees for services.
  • Dental Health Maintenance Organization (DHMO): As the name suggests, a DHMO is like a health insurance HMO. Dentists who are part of the DHMO network receive a monthly fee to cover dental services for you. Services are either free or require a co-payment. Providers get paid monthly regardless if you see a provider or not.
  • Discount Plans: Dental discount plans such as our OneSmile Dental Plan are another great way to cover preventative care and save money on restorative services. Our plan like other discount plans requires a low annual membership fee which provides members the ability to receive free dental exams and 20 to 40% savings on needed services. These plans are often combined with insurance to bring down costs for non-covered treatment.

6 tips to get the most from your plan.

We want you to use your full dental benefits and get the most from your investment. The only way you can do so is to actually take the time to visit the dentist. Here are 6 tips to get the most from your dental plan:

  • Visit an in-network provider, or, if you are on a Dental HMO plan, visit only the office to which you’ve been assigned.
  • Learn how the plan handles emergency out-of-network treatments.
  • Understand your premiums. Dental insurance is typically a separate enrollment in employer healthcare plans. The average cost per individual is $170-$370 a year while a family typically spends $325-$800 a year. Calculating your annual premium cost will boost your motivation to make use of your benefits.
  • Verify benefits coverage before making treatment decisions. Your dentist should quote you treatment costs specific to your remaining coverage, so you can make the most informed decisions about your dental care options.
  • Find out if your plan offers orthodontic coverage. The perfect smile may be more affordable than you think.
  • Beat the end-of-year rush. Many people forget to book dental appointments and then have to scramble to take advantage of their benefits before the year ends. Book early to be sure you have an appointment reserved before time runs out.

At Castle Dental, we know that rising healthcare costs are no small matter. That’s why we want to help all our patients get the most out of their benefits and why we continually stress the importance of preventative dental care to help avoid oral health conditions that can be both painful and costly. That’s also why we accept most dental plans, accept credit cards for payment, and offer flexible financing terms and our OneSmile Dental Plan for patients without insurance. Our Smile Now, Pay Later program gives our patients flexible payment plans with low interest and extended terms.

There’s a lot to think about when it comes to understanding dental insurance. You can count on us to advise you regarding what we know about your plan or what you should consider when shopping for a dental plan. If you’d like support, please give us a call at 1-800-MONARCH (1-800-666-2724) or contact us online to talk to our staff about our flexible payment plans.