Maximize Your Dental Insurance Benefits
At Pathway Dental Group, we want to help you make the most of your plan before your benefits reset. Understanding the finer details of your dental insurance can save you money and ensure you get the care you need. Let’s break down some key terms and concepts to help you navigate your plan confidently.
What is an Annual Maximum?
Your insurance plan likely includes an annual maximum, which is the total amount your insurance will pay for dental services within a year. Once you reach this limit, any additional treatment costs are your responsibility. Unused portions of your maximum don’t roll over to the next year, so use your benefits while they’re still available!
What is a Deductible?
A deductible is the amount you must pay out-of-pocket before your insurance begins covering treatment. For example, if your deductible is $50, you’ll need to pay that amount before insurance kicks in for your care. Deductibles reset annually, so if you’ve met your deductible, it’s smart to address your dental needs before January.
What is a Waiting Period?
With many dental insurance policies, there is a waiting period after enrolling in a dental plan before certain services are covered. Preventive care, such as cleanings and exams, is often covered immediately, but restorative procedures like fillings or crowns might require a waiting period of three, six, or twelve months.
What is Coordination of Benefits?
When you have more than one group dental insurance plan, such as one through your employer and another through a spouse, coordination of benefits determines how the two plans work together to cover your treatment. Typically, the primary plan pays first, and the secondary plan may cover any remaining costs, but this depends on your policies.
Does Secondary Insurance Cover What Primary Doesn’t?
In many cases, secondary insurance can help cover costs that the primary insurance doesn’t, such as co-pays or portions of treatments. However, secondary plans won’t always cover everything, and coverage depends on the details of both policies.
The American Dental Association provides additional guidance for using more than one dental insurance plan.
What is a Missing Tooth Clause?
A missing tooth clause is a policy provision stating that if a tooth was missing before your coverage began, the plan won’t cover the cost of replacing it, such as with a dental implant or bridge. This clause is common in many insurance plans, so check your policy for specifics.
Do Benefits Roll Over?
Unfortunately, most dental insurance plans operate on a “use it or lose it” basis. This means any unused benefits, such as remaining annual maximums, do not roll over to the next year. That’s why it’s crucial to schedule appointments before December 31 to maximize your coverage.
What is the Percentage of Coverage?
Dental insurance often covers treatments based on a percentage. For instance, preventive care like cleanings may be covered at 100%, while restorative procedures like fillings might be covered at 80%, and major services like crowns could be covered at 50%. The remaining balance is your responsibility. Each policy is different, so it’s important to review the documentation to determine what percentage is your responsibility compared to how much the insurance company will cover.
What is a Frequency Limitation?
Frequency limitations dictate how often certain treatments are covered. For example, your plan might cover dental cleanings every six months or X-rays once a year. If you exceed these limits, you’ll need to pay out-of-pocket for additional services.
At Pathway Dental Group, we’re here to help you understand your coverage and schedule the treatments you need. Contact us today to book your appointment and make the most of your benefits.