Dental insurance can be confusing. All of the jargon surrounding your policy can leave you wondering exactly how you should use it in order to make it a worthwhile investment. Fortunately, once you take a little time to grasp the key principles that dental insurance operates on, you should find it much easier to utilize your policy to your greatest advantage. In this blog post, we provide some insightful tips to help you do just that.
Know the Terms
Here is a quick definition of some of the key terms that you might find in your policy’s coverage description:
- Annual maximum: The most your insurance company is willing to pay out during your coverage period. A coverage period is usually one year.
- Deductible: The amount you must pay to your dentist before your insurance kicks in.
- Waiting period: The length of time you may have to wait before you can use your coverage for certain services. Most waiting periods are 6 – 12 months long.
- Coinsurance: The percentage of the cost of a treatment that you must pay after you meet your deductible. PPO plans usually require you to pay coinsurance.
- Copay: A set fee for certain services. Most policies have either coinsurance or a copay, not both.
Review Your Benefits
Dental insurance policies typically have some things in common, but the specifics can vary greatly from plan to plan. For example, a few plans only cover preventive care, but most help can help you out with restorative care as well. Other plans do not provide coverage for certain specialty services, such as dental implants or orthodontics. Before you make an appointment for a particular treatment, you should understand whether your insurance applies to it and what portion of the cost it will cover.
Remember that Benefits Expire
Many insurance plans operate on a calendar-year basis. At the end of the year, your coverage will expire if you do not choose to renew your plan. Also, keep in mind that any unused portion of your annual maximum is extremely unlikely to roll over into 2021, even if you have hundreds of benefits dollars left remaining. If you know you require a certain treatment, the best time to schedule your next appointment may be right now — before your 2020 benefits disappear forever.
Out of Network Does Not Always Mean Out of Coverage
If you have a PPO dental insurance plan, your plan’s website probably features a list of dentists who are in your network. However, that doesn’t mean you are required to visit one of those dentists. You are free to use your coverage at virtually any practice in the U.S. The biggest difference between in-network and out of network dentists is that your out of pocket costs will be less predictable at out of network providers.
Hopefully, the above information has helped you to understand your dental policy. If you have further questions about your coverage, your local dental team may be able to help.
About the Author
Dr. George A. Hoop is a general dentist with more than 30 years of experience. He provides a broad range of treatments, and he is happy to accept payment from most PPO insurance plans. To learn more about Dr. Hoop and how our practice can help you maximize your dental benefits, contact us at 239-594-8817.