Dental Insurance: 5 Tips to Maximize Your Coverage

It's that time of year again when everyone has the "use it or lose it" mindset for their dental benefits, and rightfully so. Millions and millions of dollars are saved by insurance companies simply from people not using up their benefits before the calendar year is up…And once they're gone, they are gone.

That's why we have put together this list of good-to-know items that, in addition to remembering to use them up before the end of the year, could help you learn how to maximize your insurance coverage. 

1. Understand the Main Motivation of Your Insurance Company

Your dental insurance is structured in a way that helps it save money. Like a lot of things in life, it is easier to prevent a problem before it happens. This is the main reason that a lot of insurance companies pay for 100% of your preventive care, as opposed to other corrective procedures. So, you should focus on maximizing preventative procedures well before a real issue arises. Some good examples of preventative care would be things like X-rays, fluoride, cleanings and even sealants.

2. Get Fillings, Not Crowns, Whenever It Makes Sense

In most cases, insurance companies will cover simple fillings at 80% to 100%. But oftentimes, more complicated procedures, such as crowns, are only usually covered at 50%. So, in using crowns as an example, if you had insurance coverage of 80% for a filling that costs $120.00, it would only cost you 20.00 out of pocket. Whereas if you needed something more drastic like a crown, which can cost around $240.00 but only at the 50% covered, that would mean that you would have to pay $120.00 out of your own pocket. 

4. Maximize Your Annual Limits

More often than not, most insurance companies have an annual dental insurance limit of $1,000 to $1,500 or $ 2,000 per family member. But the insurance company will usually only pay out for treatment within this range, not more. In many cases, this money will not carry over year over year. Most insurance companies wipe the slate clean and restart the following calendar year. Meaning that if you have yet to use up all of those funds, the money you are entitled to is lost forever. So work with your dentist to ensure that you always make the most of your annual limit and avoid regret when the calendar year turns over.

5. Understand Your Limits for Procedures

Many patients think that their insurance will only cover a maximum of two cleanings and detailed exams each year. But this is a bit misleading since most insurance companies cover both a cleaning and a complete exam every 6 months. These might sound like the same thing, but I can assure you they are not. To be eligible to get your cleaning covered, you would usually need to have not had a cleaning in the last 6 months. This means that the clock starts after the last cleaning you have done. That means that if you were to go to the dentist about every 8 months, you would only be getting 3 complete cleanings, and not 4 over an entire two-year timeframe. However, you would still be paying your monthly premiums for literally fewer services.

In closing, there is a lot you can do to maximize the use of your employee benefits. But it is important to understand all of your options to ensure that you are getting the most out of your annual dental insurance, and with the year-end right around the corner, remember to tie off the year right with a cleaning, exam, or another service with Sparkleen before the end of the calendar year to get the most of your benefits and remember; you can request a booking now online for a time and date that works best for you! 

Please note that insurance companies have different ways of operating their policies and that this article is based on broad observances and should not act as a technical reference. If you would like to discuss how to maximize your insurance plan's specific coverage, feel free to contact our office, and we would be happy to review it with you or contact your provider for more details.