You pay for it every month and you know it’s important, but do you understand how your dental insurance works? Your benefits can save you a lot of money when caring for your smile, but only if you use them correctly! Knowing what your insurance plan covers is essential if you want to make the most of your dental benefits. To help you get started, read to learn more about what you can typically expect when it comes to dental insurance coverage.
Understanding Annual Maximums and Deductibles
Before we get into what most dental insurance companies cover, it’s important to understand two key terms: your deductible and annual maximum. Your annual maximum is the dollar amount your dental insurance is willing to pay for your treatments in a single coverage period (which is usually one calendar year).
However, before you can start taking advantage of your annual maximum, you need to meet your deductible. Your deductible is how much you need to pay for the cost of your dental care before your insurance policy will start to cover the costs. Once you’ve paid for your deductible, your dental insurance will pay for your care up to your annual maximum.
The 100-80-50 Insurance Coverage Structure
Dental insurance policies will usually pay for different portions of different types of treatments. While every plan is slightly different, most follow a 100-80-50 structure of coverage, which means they’ll pay for:
- 90-100% of preventive care costs, like checkups, cleanings, X-rays, and oral cancer screenings.
- 70-80% of the cost of basic treatments, such as fillings and gum disease therapy.
- 50-60% of expenses incurred by major procedures, including root canals and dental crowns.
It’s important to keep in mind that every plan will have its own unique exceptions and inclusions, so you’ll need to review your insurance paperwork to know exactly what your plan covers and at what percent.
Expenses You Are Responsible for
Aside from your deductible, you’ll be responsible for a few other costs as well:
- Insurance premium: Every month, quarter, or year, you’ll need to pay a set amount to keep your coverage active.
- Co-pays: Every time you visit your dentist, you’ll need to pay a set fee before you receive your treatment.
Making the Most of Your Dental Insurance Benefits
Now that you understand some of the basics of dental insurance coverage, the next step is to learn how to make the most of them. For most insurance plans, whatever is left of your annual maximum by the end of the year expires when your policy is renewed. So, if you’ve met your deductible and still have benefits available, it’s a good idea to get any dental work you need completed before the end of the year so you can pay as little as possible for it.
If you’re still have questions about your dental insurance, feel free to talk to your dentist and they’ll make sure you’re maximizing your benefits while keeping your smile healthy!
About the Practice
Dr. Rupeshwar Renkuntla of Saginaw Dental aims to make high-quality dental care affordable for families and individuals in Saginaw alike. He’s proud to accept nearly every major PPO plan and his talented team always goes above and beyond to ensure your coverage is maximized. For patients without dental insurance or who would like more payment options, he’s also happy to provide third-party financing through CareCredit. These allow you to pay for the cost of your treatment via payments over time, often with low- to no-interest. To learn more about how your dental insurance works, feel free to contact him via his website or at (817) 989-2832.