Unlike homeowner’s or automobile insurance, dental insurance is something you definitely WANT to use. Other insurance plans are often designed to cover a loss. For example, your homeowner’s insurance will reimburse you if you lose your home to a fire or natural disaster and if your car is damaged in an accident, your car insurance pays to have it repaired. Of course, specific coverage amounts vary depending on the policy, but the premise is the same (i.e., the insured must incur a loss before they receive reimbursement). Dental coverage, however, is set up as a benefit plan, which means it covers certain costs up to a maximum amount.
The typical dental insurance plan is structured based on a 100-80-50 model. While it can sound confusing, this means that they pay for 100 percent of preventive care (exams, cleanings and X-rays), 80 percent of basic treatments like cavity fillings, and 50 percent of major procedures such as tooth extractions and root canal therapy.
In addition, dental insurance companies also set yearly maximums for the amount they will pay towards certain types of treatment. It’s common to have a limit of $1,500 to $2,000 annually for restorative procedures (fillings, crowns, etc.), and a $1,500 to $2,000 lifetime benefit for orthodontics.
While dental insurance is an asset, it’s not a complete catch-all. It is possible that some procedures recommended by your dentist won’t be covered at all by your dental plan. Another key factor is that the vast majority of dental plans are based on care delivered within a calendar year. What you don’t use between January – December of that year, you lose. So, if your plan offers $2,000 a year for restorative procedures and you didn’t need any in 2020, that $2,000 expires on December 31st. Instead of going towards keeping your smile healthy, unused funds go back to the insurance provider. To maximize your dental insurance, make sure you match or exceed your yearly maximums before they expire.
Selecting the right dental plan for you and your family is a personal choice and there are many options. Below are three of the most popular types of plans:
Between PPOs, DHMOs and 100-80-50 formulas, navigating the ins-and-outs of dental insurance can be stressful. However, our dental team is here to address your questions and help you maximize your benefits. Don’t hesitate to contact our office to discuss options or schedule an appointment for your year-end cleaning.