Dental Insurance

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It’s the most wonderful time of year. Fall has arrived. Holiday festivities, office parties, black Friday shopping, and if you have dental insurance, your insurance benefits might be about to expire.

If you have dental insurance, each month you pay a premium. If you don’t use it, it does not renew or carry over to the following year. If you did not use the benefits, you just paid for an entire year of protection, and that’s about to end on Dec 31, 2023. Going, going, gone.

Of those insured adults, 30% do not file a single claim within the year. This means that they never use their dental insurance.

Out of those who use their dental insurance, 70% end up paying more than they would have to if they didn’t have insurance. After copays, coinsurance, and premiums, the total exceeds the market value of their dental care.

Types of Traditional Dental Insurance

Dental health maintenance organization (DHMO): These plans have much lower premiums, but one must choose a primary dentist from a network of providers.

Preferred provider organization (PPO): PPOs allow more flexibility when choosing a dentist, but you pay less if you visit in-network providers.

Fee-For-Service (FFS) or Indemnity Plans: These plans allow you to see any dentist but often have higher premiums and require upfront payments.

Coverage Details

When an insurance plan states that they offer “basic coverage” that usually helps with preventative care, x-rays, and fillings, major coverage varies with each company and typically covers treatment at a percentage. For example, 50% paid by insurance, 50% paid by guest/patient, plus you pay the deductible for the year.

It is important to review the coverage details of each plan, which include deductibles, annual maximums, waiting periods, and covered treatments. Without insurance, one may end up paying more for services.

Alternative Insurance

In-office memberships: In-office memberships are the better alternative to traditional insurance. They offer exclusive membership. While the specifics vary, the general idea is that the patient pays the dentist or dental office a fixed amount for the plan annually or monthly. Preventive services are usually covered at no charge, and any other procedures (other than preventive) are then offered at a discounted rate.

With in-office memberships, there’s no waiting period, no deductible to meet, and no annual maximum. The plan design and cost are dentist-specific.

Maximizing Your Dental Insurance

If you have insurance, take advantage and get all your regular check-ups and cleanings usually covered at 100%. Prevention is key.

  • Understand Your Coverage: Read the policy carefully to know what is covered and what isn’t.
  • Know Your Annual Maximum and Deductible: This directly affects your out-of-pocket costs.
  • In Network or Out of Network: Out of network, you may pay more; in network, you may pay less, but there is usually a reason for that.
  • Going through your dentist can cut out wasted money spent on “the middle man,” which is traditional insurance.
  • Preauthorization: Obtain preauthorization from your insurer to avoid unexpected costs.
  • Utilize flex spending accounts (FSA) or (HSA) health savings accounts.

When deciding on the type of insurance to purchase, assessing your needs and considering your oral health history, frequency of dental visits, and anticipated dental procedures is important. Dental insurance can be a valuable tool in maintaining oral health, but it can also be costly if it is not used yearly or is a poor plan. To make the most of your plan, it is recommended to educate yourself about its details, prioritize preventative care, and make the most of your yearly benefits, as they do not renew.

By understanding the various coverage options, assessing your needs, and comparing plans, you can find the right plan that suits your oral health requirements and budget.

Investing in oral health is a great way to improve your smile’s longevity and overall well-being.

Happy Holidays!

To schedule a consultation, contact Daydream Family Dentistry at 956-968-6561 or visit daydreamfamilydentistry.com.

 

Dr. Rafael Carrales