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How Does Dental Insurance Work?

How Does Dental Insurance Work?

Time flies! It’s already December and 2015 is coming to an end. Did you know that your 2015 dental insurance benefits and/or healthcare flexible spending account also expire at the end of December? As such, any unused benefit dollars for 2015 are typically lost. Here are some key terms to understanding dental insurance before you let it expire.

  1. Plan Basics: Most insurance companies offer a variety of benefit plans with different features. You may have co-workers or friends who are also covered by the same insurance company, but their coverage may differ from yours. If you have a DMO/HMO plan, you can only go to your assigned provider, while with a PPO plan, you can choose your own provider.
  2. Maximums: Most plans have an annual dollar maximum, usually between $1000 to $3000. Unfortunately insurance companies have not raised the maximum covered amount since 1960s. Once you reach your annual maximum, you will be responsible for all costs above it.
  3. Benefit Period: Dental benefits are calculated within a “benefit period”, which is typically for one year but not always a calendar year.
  4. Deductibles: Just like your car insurance, you must personally satisfy a portion of your dental bill before insurance starts contributing to your cost of treatment. Plans vary on the amount ($50-100 on average) and may apply deductible to diagnostic or preventive treatments, such as cleanings while others will not.
  5. Coinsurance The insurance will pay a predetermined percentage of the cost of your treatment and you are responsible for the remaining percentage. For instance, an insurance plan will typically pay 80% of a filling or 50% of a crown.
  6. Limitations and Exclusions: For example, insurance may cover one crown for each tooth every five years, a full set of X-rays every three years and a denture every seven years. Most insurances will not cover placement of implants or whitening.
  7. Waiting Period: This is a specific period of time which the patient must wait before getting any major work done. The waiting period can range anywhere from 6 months to 12 months on standard work.

Dental insurance are designed to help cover part of your expense and may not always cover every dental need. Every plan is different and you should refer to your plan booklet for details. If you foresee extensive dental work, you may want to opt for a flex spending account and/or for the greatest coverage option your employer offers.

We know how busy families are today, but by coming in for a regular dental cleaning and exam, you may avoid future dental complications that end up costly and time consuming. Call us before your benefits expire! We are committed to the prevention of dental disease.

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