08 Oct Use it or Lose it: Your Dental Benefits May Expire at the End of the Year
In March, 2018, the Bureau of Labor Statistics (BLS) reported that 44% of civilian employees had access to dental care plans. The Center for Disease Control’s (CDC) National Center for Health Statistics (NCHS) revealed similar numbers in their 2014-2017 Health Interview Survey, which found that 45.6% to 57.1% of adults ages 18-64 had dental care coverage. While these numbers do confirm a rise in access to dental care coverage in recent years, what’s most surprising is that only 2%-4% take full advantage of their dental benefits every year. If you have dental insurance and you haven’t used up your benefits yet this year, it may not be too late. Here’s what you need to know.
How dental insurance differs from regular health insurance
Dental coverage works differently than your standard health insurance in one key way that, once explained, can help you understand why you should use up your benefits every year.
With regular health insurance, your coverage kicks in after you’ve met your deductible for the year. Your deductible is the amount you pay for health care services before your insurance pays its portion of covered services. This means, you could pay an average of $4000 to $8000 a year (depending on your plan) before you even receive any benefits. In this case, it would make sense to assume you’re actually saving money by not going to the doctor.
Dental insurance works a little differently. You may still have a small deductible ($50-$100 a year), but the insurance premiums you pay likely entitle you to a number of benefits that do not require you to pay the deductible first. For example, preventative and maintenance visits are often fully covered, so you may be able to get your checkups, x-rays, and cleanings without having to pay anything beyond your annual premiums. But these dental benefits will end after you reach the maximum amount or at the end of the calendar year. This means if you get to the end of the year, and you still haven’t had your second biannual checkup, you won’t get to make it up in the new year. You will lose these benefits, and your money will have been wasted.
How to make the most of your dental plan
As mentioned above, most dental insurance plans have a benefit deadline of December 31st, but check with your provider to be sure. Whatever the benefit end date of your insurance plan, there are some things you can do to ensure that you use all the dental benefits your premiums entitle you to.
- Start early
At the beginning of each year, make a note to schedule your checkups. Regular checkups should include exams, x-rays, cleaning, and polishing. If you know you have an appointment in February, make a note in your calendar sometime in July to schedule your second appointment for August if you don’t already have one. It’s important to remember that your insurance may not cover cleanings or checkups that are less than 6 months apart, so you won’t be able to double up at the end of the year.
- Get your cavities filled right away
If your dentist tells you that you have tooth decay, it’s always best to get it treated right away rather than waiting. The longer you wait, the higher the likelihood that a filling won’t be enough to correct the problem. Dental insurance typically pays 80% to 100% of fillings, but only 50% or less for more extensive dental work, such as dental crowns and dental implants.
- Ask for a predetermination of benefits
When your dentist recommends a course of restorative treatment, ask them to contact your insurance company to provide an estimate of what they would pay if you get the treatment. This way, you’ll know ahead of time whether or not the cost of the treatment will exceed your maximum benefits for the year.
- Plan multi-stage treatment ahead of time
Plan your multi-stage treatment in a way that allows you to maximize your dental benefits. If you can fit it all into one year without exceeding your maximum benefits, doing so will help you avoid paying a second deductible the following year. On the other hand, if the multi-stage treatment will exceed your maximum benefits, it may work best to do half at the end of one year and the other half at the beginning of the next year. While you will have to pay two deductibles, it could still work out to much less than if you’d had to go out of pocket for exceeding your benefits in a single year. It is important to discuss this with your dentist to ensure that waiting to complete the dental work will not result in complications.
Most dentists who accept dental insurance understand how it works and have experience working with patients to help them get the most out of their dental plans.
Looking for a great dental experience in San Diego? Come see us!
At Smile Designers in San Diego, we believe in providing our patients with high quality dental work, excellent service, and compassionate customer care. Come to Smile Designers to see why our patients rate us as the best dentist in San Diego. Give us a call at (619) 222-6000 to schedule a consultation today.