October 4, 2018
Have you ever kicked yourself for missing out on an opportunity to make (or save) money? You may not think about your dental insurance in those terms, but when you let a year go by without scheduling necessary dental care, that’s exactly what you’re doing! In fact, a recent study by the American Dental Association found that, while the average annual benefit is $1,250 per person, most people only get around $323 of dental work annually. Since insurance benefits are lost at the end of the year, that’s over $900 that many people are passing up. Keep reading below for tips on how to take advantage of your benefits and learn what the typical coverage is for several common procedures. You (and your wallet) will be glad you did!
Which Procedures Are Usually Covered By Insurance?
When it comes to insurance coverage, the most important thing to remember is that each plan is unique. With that said, here are some ballpark percentages for several common procedures:
- Cleanings, X-Rays and Exams – These are considered preventative and are often covered at 100%. Usually, patients get 2 checkups a year, although more frequent checkups might be covered during pregnancy or for patients who have gum disease, diabetes or cancer. Also, your plan might cover professional fluoride treatments (which are excellent for cavity prevention), so always check your benefits.
- Deep Cleanings – Deep cleanings are often one of the first recommendations for patients with gum disease and are usually covered at 60%-80%.
- Fillings and Root Canals – 60%-80% of the cost of fillings and root canals is typically covered.
- Crowns and Bridges – Many plans will cover crown and bridgework at 50% – 70%.
How Can You Get the Most From Your Benefits?
To maximize your plan, start by finding out when your plan year starts and ends. Most plans start in January and end in December, but some operate on a fiscal calendar year.
Also, be sure to schedule any appointments as soon as possible, since dental schedules fill up quickly towards the end of the year. In particular, everyone should be scheduling their routine checkups and preventive care. Since it’s usually covered at 100%, it won’t cost you a penny.
When considering your total cost for more extensive procedures, don’t forget to find out how much your deductible is. Or if you’d like a more specific figure, you can ask your dentist to file a preauthorization beforehand. This formal estimate from your insurance company will give you a breakdown of the coverage they’ll provide.
Finally, remember that most plans have an annual maximum (usually $1,000-$3,000), which is the total amount they’ll pay each year. If you need any dental work to help you achieve or maintain a healthy smile, you may as well use it – otherwise, you’re letting another year of financial benefits pass you by!
About the Author
Dr. Laura Ryan is a general, cosmetic and restorative dentist who wants every patient to get the most from their insurance plan. That’s why she and her staff do everything they can to help their patients use their benefits to their advantage. If you have any additional questions, she can be reached via her website or at (972) 727-5001.