Dental insurance can be a real beast! It can get complicated and confusing. Maximums, deductibles, allowable amounts, standard fees, preventive, basic, major, maxed out….Whew! Don’t worry, we have your back. Keep reading for some clarification and how to ensure you are getting the most out of your plan.
First of all, let’s start with the most important information. Your money. Your dental plan gives you a “maximum” amount they will pay toward dental services for the year. This generally ranges from $1000-$2000 but varies depending on your plan. It’s easy to run out of that “allowance” quickly if you have big procedures to be done. It’s also easy to forget about that money just sitting there waiting to be used. The phrase “use it or lose it” comes to mind. Unfortunately, unlike vacation days, your insurance money doesn’t rollover. So whatever you don’t use is…gone.
So, how can you ensure you use your full benefit and not run out? The key is to keep up with preventive care. Preventive is your yearly two cleanings, x-rays and exams. Preventive is just that…preventative! It helps prevent you from needing additional, more invasive work done by catching problems early. Your preventive care takes money from your yearly maximum or “allowance” while usually leaving some wiggle room for fillings or other dental work. If more expensive work needs to be done such as a root canal or crown, all your remaining benefits can be utilized towards the procedure making your cost out of pocket much less. So when an office says your insurance is “maxed out”, they mean you have used all your benefits for the year. That is not a bad thing! That means you are making progress toward a healthy mouth! If you don’t max out for the year, that money is just going to go away. However, keeping up with preventive care can avoid running out of insurance funds and help prevent costly dental procedures.
Here is an example of how an insurance maximum works:
- You need a filling.
- The fee for this filling is $200.
- Your insurance covers this basic service at 80% for you, so they will pay $160 for your filling.
- You are left to pay the remaining 20%, meaning you will only pay $40 for your filling.
- The plan has given you $1000 to use for the year.
- That 80% they just paid for you will be subtracted from your maximum total.
- $1000-$160= $840 is your remaining amount to use for the year.
I know that may still seem confusing but rest assured, your dental provider has staff who are pros at this! They can help you easily understand your policy so your benefits aren’t wasted and you are keeping as much money in your pocket as possible. Just be sure to give the office a call and let them know you want to utilize your benefits. Remember you have benefits for a full year!