Dental Blog

Don’t Waste Your Dental Insurance

Tuesday, July 2, 2019
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Have you taken your dental health for granted? If so, you’re not alone because many others do too. But, when you skip regular dental care it can lead to not only serious health consequences, but it can also hurt you financially. While approximately 47% of adults participate in employer-sponsored dental insurance plans, less than half of insured adults use this benefit according to a 2019 survey by the National Association of Dental Plans. In fact, only 4.2% actually reach their annual maximum. Since the average cost of dental insurance per individual is about $360 a year, if you don’t use it, you’re just throwing money away. To improve your comfort about and help you understand dental benefits plans and dental insurance, we gathered the information that’s important to know.

Use you dental insurance – don’t avoid it.

When it comes to understanding the details of health insurance, many of us simply avoid it. Since dental insurance is set up differently than health insurance, it’s important to understand the differences.

Insurance versus dental benefits.

Even if you’re familiar with the way insurance works, you might not understand dental insurance since it doesn’t work the same way as other insurance types. With insurance, the insurer carries the risk and it is set up to cover a loss. For example, if you total your car, the car insurance policy you have on the vehicle with pay you the value of the car. If you lose your home to a natural disaster or fire, homeowner’s insurance will reimburse you for what your home is worth.

Dental insurance only covers some services up to a maximum amount yearly since dental coverage is set up as a benefit plan. Typically, you can expect to receive free preventative care (cleanings, exams, and X-rays), $1,500 to $2,000 annually for other procedures such as filling and crowns and possibly a $1,500 to $ 2,000-lifetime maximum benefit for orthodontics. Since most dental plans are based on the care delivered in a calendar year, if you don’t use a benefit in that year, you will often lose it. It’s also important to realize that there are potentially procedures recommended by your dentist that insurance won’t cover at all. Health insurance deductibles are usually much higher than dental insurance deductibles (often under $100) so people tend to focus on getting health procedures done before the end of the year so they can take advantage of a maxed out deductible but don’t have the same urgency with the lower-deductible dental insurance plans.

What’s included in dental coverage?

This is intended to provide you with an overview of what is generally covered with dental benefits, but be sure to take a moment to understand what is covered with your particular policy because it could be different. Many dental policies cover two cleanings and two dental exams a year, otherwise known as preventative care. Other services won’t be covered at 100% because they are designed around maximum benefits instead of a cost-of-care model. Here are terms you might see used on your dental benefits materials:

  • Pre-existing conditions: Learn what your plan defines as pre-existing conditions and if they will be covered.
  • Least expensive alternative treatment (LEAT): If your plan has a LEAT clause, the policy will only cover the least expensive treatment if there is more than one treatment possible.
  • Coinsurance: Coinsurance is the portion of the charges that you will need to pay. An 80/20 plan would mean that the benefits provider would take care of 80% of the charges and you would be responsible for the remaining 20%.
  • Deductibles: Before your plan will begin to pay for services, you will need to meet your deductible within a calendar year. If you have exceeded your deductible in a year, it’s always a good idea to schedule treatment that you have been putting off before the deductible resets.
  • Annual maximums: There is a limit to what your plan will pay each year and that’s the annual maximum. If your plan pays for $1,500 a year, but your services cost $2,000, you would be responsible for paying the $500 difference out of pocket.

Many dental benefits plan providers will request that they review a treatment plan before any services begin or are authorized. The plan’s administrator will review the treatment plan, decide if it is authorized, and how much the plan will pay. It’s better to know before services begin what is and isn’t covered.

Dental plans.

Here are some of the most common dental plans you will see when reviewing dental benefits plans:

  • Discount Plans: Dental discount plans offer an option for patients to cover their preventative care and save money on restorative services. Plans such as our OneSmile Dental Plan require a low annual membership fee which provides members the ability to receive free dental exams and 20-40% savings on needed services. These plans are often combined with insurance to bring down costs for non-covered treatment.

  • Dental Health Maintenance Organization (DHMO): As the name suggests, a DHMO is like a health insurance HMO. Dentists who are part of the DHMO network receive a monthly fee to cover dental services for you. Services are either free or require a co-payment. Providers get paid monthly regardless if you see a provider or not.

  • Preferred Provider Organization (PPO): You might be familiar with the PPO term from health insurance enrollment. When you are part of a PPO dental plan, you must go to a dentist within the PPO’s network to get your full benefit. These dentists have agreed to the PPO’s established fees for services. The services that are covered depends on the PPO plan. And if you receive any services from an out-of-network dentist, you can expect to pay in full since the PPO will only cover services performed by an in-network provider.

Tips to get the most from your plan.

Since you’ll be paying for dental coverage with premiums, co-pays, and deductibles, you want to get the most value for the benefits you decide to purchase. And the only way to benefit from your dental insurance is to actually visit the dentist to receive care. Get the most out of your plan by following these tips:

  • Beat the end-of-year rush. Don’t leave scheduling your dental appointments to the end of the year. It’s better to book early so you can be sure is time to get your dental procedures completed before the end of the year.
  • Select an in-network provider, or, if you are on a Dental HMO plan, visit the office you were assigned.
  • Understand your premiums. Dental insurance is typically a separate enrollment in employer healthcare plans. The average cost per individual is $170-$370 a year while a family typically spends $325-$800 a year. Calculating your annual premium cost will boost your motivation to make use of your benefits.
  • Find out if your plan offers orthodontic coverage. Your perfect smile might be more affordable than you think.
  • Verify benefits coverage before making treatment decisions. Your dentist should quote you treatment costs specific to your remaining coverage, so you can make the most informed decisions about your dental care options.
  • Find out how the plan handles emergency out-of-network treatments.

At Monarch Dental, we know that rising healthcare costs are no small matter. That’s why we want to help all our patients get the most out of their benefits. It’s also why preventative dental care is critical to help avoid oral health conditions that can be costly and painful. We accept most dental plans, accept credit cards for payment, and offer flexible financing terms and our OneSmile Dental Plan for patients without insurance. Our Smile Now, Pay Later program gives our patients flexible payment plans with low interest and extended terms.

There’s a lot to think about when it comes to understanding dental insurance. You can count on us to advise you regarding what we know about your plan or what you should consider when shopping for a dental plan. If you’d like support, please give us a call at 1-800-MONARCH (1-800-666-2724) or contact us online to talk to our staff about our flexible payment plans.