4 Tips for Understanding Your Dental Insurance

To keep your teeth and gums in tip-top shape, it is crucial to visit your dentist every six months for a dental checkup and professional cleaning. However, the exam alone can range anywhere between $50 and $300, and that doesn’t include X-rays or fluoride treatments. Fortunately, that’s where dental insurance comes in! If you are not familiar with your policy, here are four tips to help!

#1. Learn the Basic Terms

• Benefit period – This is the time between your “effective date” and the “end date.” If you do not renew before your end date, you will no longer have coverage.
• Co-payment – This is typically a flat fee per visit/treatment that the patient is responsible for paying.
• Coinsurance – This is a percentage that the patient is required to pay after the insurance company has paid their portion.
• Deductible – Like homeowner’s insurance, a deductible on your dental plan is the amount you must pay out of pocket before your insurance company pays for any treatments.
• Maximum – Your annual maximum is the amount your plan will cover in your benefit period. On the other hand, your lifetime maximum refers to the dollar amount your insurance provider will ever cover toward the cost of treatment.

#2. Utilize “100-80-50” Coverage

Although every policy is different, dental insurance plans are usually all centered around preventive care. So, don’t be surprised to see the sequence “100-80-50” across your paperwork. This refers to 100% of diagnostic services (like checkups and cleanings), 80% of basic procedures, and 50% of major treatments being covered.

#3. “Out of Network” Does Not Mean “Out of Coverage”

In the medical world, “out of network” does translate to “out of coverage.” However, when it comes to dental insurance, the term “out of network” may mean that coverage is still available, but that your insurance provider will contribute a lower percentage. In fact, sometimes the price difference between using an in-network and out of network provider is relatively nominal!

#4. Don’t Hesitate to Ask for Help

If attempting to decipher the paperwork is giving you a headache, then don’t hesitate to ask for help from your insurance provider or your dental team. Both parties handle dental plans on a daily basis, so they are highly knowledgeable and are happy to help you better understand your plan.

Dental insurance plays a crucial role in making dental care affordable. That way, you can achieve pristine oral health without worrying about a hefty bill at the end of your visit!

About the Author

After completing his undergraduate degree at Boston College in Chestnut Hills, Dr. Jonathan Aguilar earned his dental doctorate at Texas A&M College of Dentistry. Today, he uses his extensive experience, advanced training, and genuine passion for his craft to help his patients achieve optimal oral health and gorgeous smiles. If you have additional questions about your dental insurance, don’t hesitate to visit his website or give him a call at 940-566-5332.