If you’re lucky enough to have dental insurance coverage through your employer, you should visit our Mesa, Arizona dentist to take advantage of all of the benefits your plan has to offer. Dental coverage is separate from medical insurance but the benefits are fairly easy to understand. Here are some of the main features that you should know about your dental insurance plan before benefits expire on December 31st.
Your Dental Insurance Benefits Explained
Every twelve months your dental insurance gives you an allowance. Meaning they will pay for a certain percentage of each treatment that you need, up to a specific dollar amount. Some plans allow $1,000 per year while others can pay as much as $5,000
Dental Insurance Benefits Expire At The End of The Year
After the twelve-month period, your allowance will expire. Typically plans run from January to the end of December, but there are companies whose insurance benefit year is different.
What Benefits Does Dental Insurance Offer?
So, what can you expect your plan to pay for? Remember that every plan is different, but to give you an idea, here is a breakdown of the typical dental insurance plan:
- 100% Prevention-Based Coverage 一 The preventive category refers to regular cleanings, x-rays, and diagnostic examinations. These procedures help “prevent” dental issues therefore insurance plans cover them at 100% to encourage you to have them done regularly. Cleanings are typically paid for twice per year and x-rays and exams are once or twice per plan year. Though these procedures are paid at 100%, they do count toward your yearly maximum.
- Reduce the Cost of Treatment
Your plan will pay a certain percentage of all other dental treatments and you’ll be responsible for paying the portion that it doesn’t cover. The amount it pays depends on the category of the specific treatment. For example, you can expect the following:
- Restorative Treatment 一 This category consists of procedures done to restore a tooth like a filling or a crown. Typically, these treatments are paid at 50-80%.
- Endodontic Treatment 一 A root canal or root canal-related treatment is often paid at a lower percentage than restorative care.
- Oral Surgery 一 The most common oral surgery procedure is the removal of a tooth which you can expect to have covered at 50 or sometimes 80%.
- Prosthetics 一 This category consists of tooth replacement prosthetic appliances like partials or dentures, which are often covered at 50%.
- Periodontics 一 If you have gum disease then you’ll need more than just the standard cleaning. Treating periodontal disease involves removing calculus buildup from beneath the gum line and along the root surface of your teeth. This in-depth treatment is typically covered at 50%.
- Orthodontics 一 The cost of braces and clear aligner therapy actually goes toward a separate allowance that’s given to you by your dental insurance plan. Orthodontic benefits have a one-time use benefit and cover a portion of your treatment fee.
- Implants 一 Dental implants aren’t covered by all insurance plans but those that do typically will pay for half of the treatment up to your annual maximum.
- Cosmetic Dentistry 一 Cosmetic procedures like whitening, veneers, or bonding aren’t covered by dental insurance plans.
Dental Insurance Waiting Period
It’s important to note that if you have new insurance coverage, your plan may come with a “waiting period”. This period means that there are certain procedures they won’t pay toward until you’ve had the insurance coverage for a certain amount of time. Commonly a waiting period will be twelve months but you can look at this and all other insurance benefits by reading your plans Explanation of Benefits form.
You Lose What You Don’t Use
Unused insurance benefits don’t roll over to the next benefit year. If you don’t use the entire allowance that your plan offers before the end of the twelve-month period you will lose those benefits altogether. So if a dentist tells you that there’s a treatment you need, you’ll want to have it done as soon as possible. Both to take advantage of your insurance benefits before you lose them and before the issue becomes a bigger one to deal with.
Get The Most Out of Your Dental Insurance
Since you’re paying a dental insurance premium every month, you wat to get the most out of what your plan has to offer. If you haven’t done so recently, visit Dr. Vinh Huynh, DMD, and the team of Eastport Dental in Mesa, AZ for a cleaning and checkup. If you need other dental work completed, we’ll be happy to discuss your insurance benefits with you and get you fixed up right away.
Give us a call today before your benefits expire.
