Insurance is always a pain to deal with. The industry seems to use its own, archaic form of English, where simple terms like “year” don’t necessarily mean a year. Then there are all of the options, the math, and the rules. It’s almost like insurance plans are designed to make things so confusing, you’re likely to make a mistake that saves them money.
Unfortunately, dental insurance is no different. But having insurance can not only save you a lot of money; it can also help you get treatments that you otherwise couldn’t afford. To help you navigate through some of the confusion, here are some tips for getting the most out of your dental insurance plan for dental care from our Leesburg, VA dentists. Bear in mind that there are thousands of different plans out there, so your particular insurance might be a little different.
Know how your insurance defines “year”: Most dental plans limit services and costs per year. For example, one plan might pay for only two dental cleanings and exams each year. The problem is that insurance companies can define the term “year” to mean different things. Some mean a literal calendar year; it starts on January 1 and ends December 31. That means you can squeeze in extra treatments in November or December. But other companies start their year on the day your coverage was purchased or came into effect. If your new job gave you benefits starting July 1, your year could run from that date through June 30. Make sure you’re absolutely clear on how your insurance plan defines a year so you don’t miss treatment you could have gotten for little or no cost.
Know your deductible and what it includes: Your deductible is the amount you have to pay before your insurance starts paying for things. If your deductible is $500, you would have to pay $500 each year (however they define a year) before your insurance would help pay for, say, a dental crown. However, many plans have preventive treatments that are exempt from deductibles and are always covered. Since it saves the company money in the long run, they want you to get preventive care now. Exams, cleanings, and fillings are often covered regardless of your deductible. However, every plan has its own list, so check with yours first.
Find a dentist in your network: As with medical insurance, dental insurance is helping reduce costs by creating a network of dentists. Often, you can still go to any dentist you want. But if you pick a dentist on your insurance plan’s list, you usually save money. Before making an appointment, contact your insurance company and make sure our dentists at Family First Dental & Implant Center are on their list.
Get regular cleanings and exams: Insurance companies know that a little work now can save a lot of money later on, which is why they usually cover 100 percent of the costs for twice-yearly dental cleanings and exams. You can save money just by taking advantage of that fact. But by giving our dentists the opportunity to clean your teeth and conduct a thorough exam, we can spot and even treat dental problems early on. For example, which do you think would save you more money: getting a composite filling in a cavity, or letting the cavity get so big that we have to do a tooth removal and replace it with a dental implant?
Understand coinsurance: Yes, dental insurance plans often pay 100 percent of preventive care like cleanings and exams. But other treatments are not covered completely. Your insurance will pay only a portion of the costs, and the remaining balance is your coinsurance. If your plan says the coinsurance for a dental crown is 15 percent, that means they will pay 85 percent of the treatment cost. Most plans will have different coinsurance rates for different treatments, so look for what your particular plan will cover the most. If you have to choose an implant or a bridge to replace a lost tooth, and your coinsurance for implants is 50 percent but only 10 percent for bridges, you might get more value by going with a bridge.
Know your out-of-pocket maximum: Most plans have an out-of-pocket maximum that limits how much you would have to pay for needed dental care each year. If your out-of-pocket is $2,000, you wouldn’t have to pay more than $2,000 in deductibles and/or coinsurance in one year. That said, every plan is different. Some do not include deductible costs, and, as noted above, some have different ways to calculate a year. Plus, this normally applies only to needed treatments, not something optional like teeth whitening. But knowing your maximum can help you get the most bang for your dental buck.
Dental insurance is both wonderful and frustrating. If you have any questions about your insurance, give our Leesburg, VA dental office a call today at 703-297-4353 or contact us online!