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What Does Your Dental Insurance Plan Cover?

December 8, 2020

Filed under: Uncategorized — drvalentine @ 12:26 pm
confused woman wondering what her dental insurance plan covers

About three out of every four Americans have some form of dental insurance, according to the National Association of Dental Plans. However, many people aren’t quite sure how dental insurance works. As a result, they often end up paying much more than they need to for their treatments. In order to make the most of your benefits, it helps to learn about the basics. Continue reading as a dentist breaks down some important dental insurance terms and what you can expect your plan to cover.

Dental Insurance Terms to Know

The jargon your dental insurance paperwork uses can be confusing at first. To make understanding your policy easier, here are some key terms to know:

  • Deductible: How much you must pay out-of-pocket before the insurance company steps in and begins paying for your care.
  • Annual maximum: The highest dollar amount your insurance company will put toward your care in a given period (typically a calendar year).
  • Premium: The amount you have to pay each month to qualify for insurance coverage.

The 100-80-50 Rule of Dental Insurance Coverage

While every dental insurance policy differs, most of them follow a similar structure in terms of which services are covered. The 100-80-50 rule usually looks something like this:

  • Preventive care (checkups and cleanings) is 80-100% covered.
  • Minor restorative treatments (fillings and gum disease therapy) are 70-80% covered.
  • Major restorative procedures (dental crowns and root canals) are 40-50% covered.

Depending on your specific plan, services may fall under different categories and might qualify for different levels of coverage. To understand your full list of benefits, exclusions, and limitations, you’ll need to consult with your insurance company or have a member of your dentist’s team examine the details of your plan.

How to Make the Most of Your Dental Insurance Benefits

Research indicates that the vast majority of Americans with dental insurance leave almost $1,000 in unused benefits on the table every year because they don’t meet their annual maximums. In most cases, these benefits do not roll over into the following year. If this happens to you, it means you’ve essentially paid your premiums for nothing!

To prevent your premiums from going to waste, schedule any needed dental work before the year ends. Also, attending two checkups and cleanings a year can save you a great deal of money in the long run. Routine preventive visits allow your dentist to detect and treat small problems before they become larger (and more expensive) issues.

Now you should have an idea of how to make the most of your dental insurance. If you’re still unsure of some aspect of your plan, your dentist and their team would be happy to help!

About the Author

Dr. Julie Valentine has been meeting the dental needs of the Beverly Hills community for more than 25 years. She obtained her Doctor of Dental Surgery degree from the University of the Pacific in San Francisco. If you’re looking to save money on dental care, or you have insurance questions, visit Dr. Valentine’s website or call (310) 551-2955.

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