When it comes to taking care of smiles, many patients worry about how much their treatments will cost. It’s easy to imagine being faced with a big bill, but one way you can make these visits more affordable is with dental insurance. However, you should understand your plan so you aren’t surprised by anything. To help you learn more about it, here are four things that you may see.
1.) Deductible
Dental plans often have an annual deductible. This is a number that you’ll have to pay yourself before your insurance provider will start to cover a portion of your treatments. Typically, if you pay more per month/year, then you’ll likely have a lower deductible.
Although it’s an out-of-pocket cost, preventive care usually doesn’t apply to it. You might be able to get twice-yearly checkups and cleanings without worrying about paying for the entire service yourself.
2.) Reimbursement Level
Once you reach your deductible, your reimbursement level will kick in. This is how much your provider is willing to pay for specific treatments. Your exact coverage depends on your plan, but many often follow a 100-80-50 payment structure.
In short, this means they’ll cover 100% of preventive care, 80% of basic services (such as fillings), and 50% of major restorative ones (like crowns). In order to know more about what your plan offers, you can talk to your insurance directly or to your dentist’s front desk team.
3.) Yearly Maximum
When you start getting coverage for your treatments, then the amount your plan is paying for will start to count towards your yearly maximum. This is the total your insurance will cover for your dental care. Once you reach it, then you’ll have to start paying out-of-pocket. Generally, it can range from $1,000 to $2,000, but it’s possible for yours to be different.
Oftentimes, yearly maximums and deductibles reset on January 1st every year you have it. That means you’ll need to reach the latter again, but the former will be zero, so you can get the coverage you’re looking for.
4.) Co-Payments & Coinsurance
In many cases, an insurance plan has one or the other, but here’s what you need to know about both:
- Co-payments are a flat fee that you’ll pay for a particular treatment. It may be collected before your service or afterward, but it often doesn’t count toward your deductible.
- Coinsurance is a percentage you’re responsible for in a specific service. As an example, if your coinsurance is 20% for fillings, then your provider is paying 80% of the bill, and you’ll cover the remainder.
Keep these in mind while you navigate your dental insurance. It can be confusing at first, but learning about your plan can help you feel more confident using it to get toward affordable care.
About the Author
Dr. Bart Miller earned his dental degree from the University of Texas Health Science Center in San Antonio and completed his orthodontic residency at Baylor College of Dentistry. He now has over 20 years of experience helping the local communities get the straighter smiles they love with braces or clear aligners.
Dr. Miller is proud to accept dental insurance, being in-network with certain plans. If you want to learn how he can use it for your treatments, schedule an appointment or call either of the convenient offices in Rockwall or Canton.
