Wondering how your dental insurance coverage works? Don’t worry – you’re not alone. Insurance policies can be confusing and aren’t always easy to understand. If you’ve never benefited from dental insurance specifically, then navigating your coverage can be particularly challenging!
To get a better grasp on how to make the most of your premium, read this beginner’s guide. Though even if you’re not a beginner, you might find some useful tips.
Dental Insurance Vs. Medical Insurance
Generally speaking, you invest in medical insurance to cover emergency treatment that would otherwise put you in a financial jam. Besides also being a separate policy, dental insurance is a bit different in that the emphasis is on preventing emergencies. Biannual checkup and cleaning appointments reduce your risk of oral illness so much that most providers cover 90% to 100% of these appointment costs.
Basically, if you’re not getting a checkup and cleaning every six months, then you’re missing out on most of your coverage!
How Coverage is Typically Split
If preventative care is typically covered at 90% or 100%, what about other types of dental services? It depends on your individual plan, but most splits look something like this:
- 100% – 90% – Preventative care (checkups and cleanings, fluoride treatments, etc.)
- 80% – Basic procedures (“simple” treatments like fillings, non-surgical extractions, and root canals)
- 50% – Major procedures (“extensive” work like crowns, dental implants, bridges, dentures, and oral surgery)
As for orthodontics like metal braces or clear aligners – that’s technically a separate option that you may have to pay a little more money for. If you have a barebones plan, your insurance likely doesn’t cover orthodontics.
Beware the January Reset
Now, dental insurance is similar to medical insurance in that you’ll have a deductible, waiting period, annual maximum, and other such restrictions that will influence when your coverage is actually applied. Checkups and cleanings typically aren’t subject to deductibles, for example, but if you need more involved treatment, you’ll have to spend a certain amount of money out of pocket before your benefits will kick in.
This is important to note because any progress you’ve made towards your deductible and other thresholds will completely reset on January 1st. Depending on the time of year, you may want to schedule a visit before your deductible resets – or after your annual maximum is back at $0.
Your Dental Team Can Help
If you’re still not quite sure how best to apply your insurance benefits, don’t worry. Many patients rely on their dental team for getting max coverage. They work with dental insurance every day, after all, and are well-equipped to help you save money. Ask them for assistance or clarification if you need it, and they’ll be happy to help!
About the Author
Dr. Navkiran Dhillon is proud to be part of a team that emphasizes affordable treatment and quality dental care. Her office is in-network with Blue Cross Blue Shield, Delta Dental, and Cigna, but even if you’re not covered by one of these providers, you could still save money. To learn how Dhillon Family & Cosmetic Dentistry can help you afford dental treatment, call 413-967-7140.