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Getting The Most Out Of Your Dental Insurance Plan

Closed up teeth smiling | Milllburn Dental Arts | New Jersey

Dental insurance is a great thing. It can save you a ton of money, and it can be the difference between suffering and getting problems solved. That doesn’t mean it’s always easy. Dental insurance plans seem to be written in a strange form of English. They can be hard to understand.

At our Millburn, NJ dental office, we want you to get the most from your dental insurance plan. Here are six tips for maximizing your benefits so you can get the care you need.

Getting The Most From Your Dental Insurance

  • Know your deductible and if anything is exempt from it. A deductible is a dollar amount set each year that you have to pay before your insurance kicks in. If you have a $750 deductible, you’ll have to pay $750 each year before the plan starts paying its portion of dental treatment charges. By knowing this, you can plan your dental treatments to get the most covered. If you need teeth whitening and a CEREC dental crown placed, doing them in separate years means you’ll have to pay more. If you get both done under the same deductible, you’ll get past it faster. Your insurance company will pay more, meaning you will pay less.
  • Also, some plans exempt certain treatments from deductibles. For example, a plan might say that digital X-rays are not subject to your deductible. That means two important things. First, you won’t have to pay all of that cost even if you haven’t paid all of your deductible. Second, the cost of the treatment will not apply to your deductible.
  • Understand your coinsurance rates for different treatments. While there are exceptions, insurance plans usually do not pay 100% for a treatment. Instead, they pay a certain percentage. The remaining percentage is called coinsurance. That’s your cost. If a treatment costs $100 and your coinsurance is 20%, your insurance will pay $80. You’ll have to pay $20. (That’s still a great deal.)
  • Most plans have different coinsurance rates for different treatments. You could have a 10% coinsurance for fillings, 20% for CEREC crowns, and 30% for Invisalign. Knowing how much you will have to pay with coinsurance lets you know how to maximize your benefits. If you have a choice between two similar treatments with 20% and 30% coinsurance rates, why not go with the 20%?
  • Find out if you have a copay and what that exactly covers. Some plans treat office visits the same as any other treatment. It has a coinsurance but only when you’ve met your deductible. Other plans have what’s called a copay. This is a set dollar amount that you pay. If your copay is $20 per visit, you pay $20 regardless of your deductible or coinsurance. (Of course, this means that $20 does not go towards your deductible.) Having a copay can make it cheaper, so you can get the most from your plan by knowing what you have a copay for.
  • Check to see what your out-of-pocket maximum is set at. Almost every dental insurance plan has a maximum that you will pay each year. This is usually called the out-of-pocket maximum. If yours is set at $4000, the most you’ll pay that year (including deductible and coinsurance payments) is $4000 total. If you go beyond that, your insurance will pay 100% of accepted charges. If you need a lot of work, such as several CEREC dental crowns and dental implants, having them done in one year could reach your maximum and save you money.
  • Understand how your insurance company defines a year. Speaking of years, check your plan. Dental insurance companies can define a year differently. These are usually called “benefit periods”. Some use a calendar year, meaning your benefit period runs from January 1 to December 31. Others start the year when you first pay for coverage. Still others can use a fiscal year.

You need to be completely clear on how your plan defines a year because most plans limit care based on that year. Your deductible is yearly. If you get treatment in March but your benefit period starts anew in February, your deductible will reset to zero by the time you visit our Millburn, NJ dental office. The same is true for treatments exempted from deductibles. Don’t get caught by not knowing when the year resets.

  • Come to our Millburn, NJ dental office for cleanings and exams at least twice each year. Insurance companies balance helping you with keeping costs low. They’re smart enough to realize that preventive care can be less expensive in the long run. Catching a cavity early means you get a small filling instead of a CEREC dental crown. That saves the company money. Many plans cover two visits for cleanings and exams each year for free. Getting free care is just about the most you can get from your dental insurance.

If you have any questions about insurance, please contact your insurance company. It’s their rules, so they can best answer those questions. When you know how to get the most from your plan, call us at (973) 957-1604.

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