All insurance plans can be a bit confusing. Some can even be frustrating. However, they are vital to keeping you healthy and pain-free. Without dental insurance, you would have to pay the full price for every visit and treatment. That’s not something most people can readily afford.
In order to use your dental insurance effectively, you need to know some important terms. Terms like “benefit year” might seem simple, but making a mistake with that term can be costly. Others, like “preventive care,” can vary between different insurance plans.
Essential Dental Insurance Terms
– Coinsurance: There are some dental treatments that insurance plans might cover completely. These are usually dental exams, dental cleanings, and similar preventive care. But for the most part, your insurance will only cover a certain percentage. The percentage left over is called the coinsurance. This is your responsibility. For example, your plan might split the costs of a root canal 70/30. They would pay 70% of the cost, leaving the other 30% for you. The coinsurance rate can vary depending on the cost and rarity of a dental treatment.
– Copay: Some plans try to make it easier to visit our Rochester, MN dental office by giving a set price for a regular visit. This is called the copay. If you have a copay of $20, then you would have to pay $20 when you come in for your visit instead of a coinsurance percentage. Note that copays do not normally cover everything that happens. For example, if you get teeth whitening at a visit, the copy won’t cover the costs of teeth whitening.
– Network or PPO list: To help reduce costs, insurance plans make deals with dentists. If the dentist agrees to lower their prices a bit, the company will encourage people to visit that dentist. This is usually called a network, though some plans call it a PPO. To discourage you from visiting dentists outside of your network, your insurance can pay less — forcing you to pay more.
– Benefit year: Many dental insurance benefits are limited to so many times each year. That’s to stop someone from getting a dental cleaning every week. The company would end up paying a lot, and your insurance premiums would go up in response. However, each company can define “year” differently. Some use calendar years, while others start a “year” on the first day your insurance is effective.
– Annual maximum: This is the most your company will end up paying each year. If you get dental treatments that total more than this maximum, the insurance company simply stops paying for anything. It’s another way to control costs and make sure one person doesn’t overuse dental insurance.
– Deductible: As with medical insurance, most dental insurance plans have a deductible. This is the amount each benefit year that you will have to play before the insurance kicks in. If you have a $500 deductible, plan on paying $500 each year before worrying about coinsurance. (In most plans, copays are not counted when figuring out if you reached your deductible.)
– Out-of-pocket: The amount you end up paying for any reason. Many plans have an out-of-pocket maximum, meaning you will only be asked to pay a certain amount. After that has been reached, the insurance will pay for almost everything.
– Waiting period: A time when you have to wait before getting certain dental treatments done. For example, your plan might have a six-month waiting period before you can get coverage for dental crowns.
– Preventive care: Insurance companies want to keep their costs low. That’s why many pay 100% of the costs of preventive care. That’s because it’s cheaper for the insurance company to pay a little now instead of a lot later. If you go in for a dental cleaning, you can help prevent expensive treatments like root canals. However, each plan has its own definition of what treatments are preventive.
How To Use Dental Insurance Effectively
– Make sure your dentist is part of your insurance plan’s network or PPO list. This can save you a lot of money.
– Since most plans pay the entire cost of preventive care, check to see what your plan defines as “preventive.” Then call our Rochester, MN dental office to schedule an appointment for those treatments. Dental exams and dental cleanings are the perfect examples.
– Check out your insurance plan’s coinsurance rates to see what they cover the most. Then call our dental office to schedule appointments for the treatments that you need but have the lowest coinsurance rate.
– Make sure you know if any treatments are not covered yet and when your benefit year begins and ends.
At our Rochester, MN dental office, our team will help you file your insurance claim and help you get the most out of it. Call us today at 507-315-2932 for your next appointment.