Many people avoid the dentist because they are unsure how much the treatments they need are going to cost. It doesn’t help that navigating your dental insurance can be confusing to deal with, but how can you tackle the daunting challenge of understanding it? Visiting your dental office can help, as they will help you get the most out of your coverage. It’s still a good idea to learn more about how your plan works, so continue reading to learn four things most dental insurances have.
1.) Deductible
Most dental plans have an annual deductible. This is simply the amount of money you have to pay out of pocket before the insurance policy covers any of your dental treatments. Generally, the more you pay every month or year for your dental insurance plan, the lower the deductible.
The good news is that preventive services like checkups and cleanings typically don’t apply to it. That means you can have the care you need without worrying about paying the entire amount yourself.
2.) Yearly Maximum
Similarly to your deductible, the yearly maximum is the total amount that your insurance will pay toward the cost of your dental care. Once you reach your yearly maximum, you’ll have to start paying for your dental care out of pocket again until your plan renews. Each dental insurance plan is different, but the average coverage maximum ranges from $1,000 to $2,000.
One thing to note is that most dental insurance plans renew on January 1st every year, and when this happens, both the deductible and yearly maximum are reset to zero. That means that while you’ll need to reach your deductible again in order to get coverage from your dental insurance plan, your yearly maximum will also be reset.
3.) Co-Payments & Coinsurance
Both of these terms may sound similar, but it’s important to know which one is used in your insurance plan, as they usually have one or the other.
A co-payment is a flat fee that you pay during a visit or specific treatment; you’ll often pay this at the start or end of your appointment. However, it may not count toward your deductible.
Coinsurance is the amount that you are responsible for paying for a specific dental treatment after meeting your deductible. It is usually a percentage, so if you have a 20% coinsurance, then your insurance will pay 80% of the service, and you’ll be billed the remaining 20%.
4.) Reimbursement Level
Your reimbursement level refers to how your dental insurance will cover your treatments after you reach your deductible. Since every dental insurance plan has its own coverage rules, it’s best to ask either your dental office’s insurance coordinator or your insurance provider to confirm which treatments are included.
That being said, most plans generally follow a 100-80-50 payment structure. That means they’ll typically cover 100% of preventive care (checkups and cleanings), 80% of basic treatments (such as cavity fillings), and 50% of major restorative procedures (like dental crowns).
Getting to know the ins and outs of your dental insurance plan will let you get the most out of your benefits while avoiding out-of-pocket expenses. If you need some help understanding your dental coverage, you can call your insurance provider or talk to your dentist office’s insurance coordinator.
About the Practice
At RiverPlace Dental, we are here to help make your dental needs more affordable for you. Our insurance coordinator, Debbie, has over 20 years of dental experience that she uses to help patients maximize their insurance benefits. We are proud to be in-network with many insurance providers, including Aetna, Delta Dental, MetLife, and UnitedHealthcare. If you have any questions about whether we accept your dental insurance or need help navigating it, visit our website or call our office at (503) 761-1414.