You already understand the benefits of dental insurance for paying for necessary oral healthcare treatment. Otherwise, you would have never signed up in the first place! But how well do you understand the basics of your plan? Do you know what is covered? Do you know when you should plan to use your available funds? Instead of trying to figure it out on your own, here are 4 key things to remember when it comes to dental insurance.
Dental Insurance Covers Primarily Preventive & Restorative Care
You will notice that your plan covers preventive and restorative treatments. This often includes dental checkups and cleanings, simple extractions, X-rays, root canals, dental fillings and crowns, bridgework, dentures, and more.
Cosmetic dentistry is typically not covered because these services are considered elective and not medically necessary. Exceptions exist, but your dentist must provide a clear explanation to the insurance company for approval.
Not All Dental Plans Have a Waiting Period
A waiting period is the timeframe between when your plan starts and when you can receive treatment. These are generally 6 to 12 months, but some are shorter or longer, depending on your policy. Most preventive services do not require a waiting period, but more complex treatment, such as a root canal or dental crown, may require you to wait.
Some companies believe these timeframes are necessary to prevent individuals from starting a plan only to cancel it after undergoing treatment.
You Will Receive an Annual Maximum
When you enroll in a dental insurance plan, you will notice an annual maximum. This is the amount your insurer will pay in a single year. Your coverage amount depends on your monthly premium. If it is higher, you can expect your annual maximum to be as well. Once you reach this amount, you are expected to pay the full amount of your dental care out of pocket.
Your Dental Benefits May Not Roll Over
Most dental insurance companies build their plans to last one calendar year. This means you must use your available benefits within 12 months to avoid losing funds. Most do not roll over, so if you still have money to use as part of your annual maximum, you’ll want to ask your dentist what you can do to improve your oral health to prevent missing out on coverage your insurance company provides.
Knowing how to use your dental insurance will help you save throughout the year, but if you have any questions, don’t hesitate to ask your team at your next visit.
About the Author
Dr. Todd Balington is an in-network dentist with many PPO dental insurance plans. His experience and advanced training allow him to provide preventive and restorative treatments that are covered by most policies. This helps patients like you save more each time you visit his office. If you are unsure how to use your benefits, visit our website or call (940) 383-3300 to learn more.