Dental insurance can seem confusing at times. Especially if you are new to your plan, you may wonder how it works and how you can use it to minimize the cost of your oral healthcare. While every policy is unique, many preferred provider organization (PPO) dental insurance plans share some common concepts. In this blog post, you will learn four key points that will get you on the road to understanding your benefits.
Most Plans Use a 100/80/50 Structure
Many PPO dental plans follow a 100/80/50 model. That means your plan may cover:
- 100% of preventive care, such as exams and cleanings
- 80% of basic services, such as fillings
- 50% of major services, such as crowns and bridges
Of course, these details can vary based on whether you have a premium or basic plan, how long you have had your policy, and other factors. If you are unsure about your coverage levels, ask your insurance company or your dental care team.
Deductibles, Waiting Periods, and Annual Maximums Apply
Your deductible is the amount you must pay before your benefits help with certain services. Preventive care does not always require a deductible, but basic and major care often do. Some plans also include waiting periods, which means you must keep the plan for a set time (usually 6 – 12 months) before it will pay for specific treatments.
In addition, most plans have an annual maximum, which is the highest amount the insurance company will pay within one benefit year. Once you reach that limit, all care costs come out-of-pocket. For many plans, the annual maximum is somewhere between $1,000 and $3,000.
Network Status Can Affect Costs
Your costs may change based on whether your dentist is in network or out of network. An in-network dentist has agreed to certain fees with the insurance company, so your out-of-pocket cost are likely to be attractively low. An out-of-network dentist may still accept your plan, but you will probably end up paying more than you would with an in-network provider.
Benefits Start Fresh Each Year
Most dental insurance benefits reset at the start of each calendar year. If you do not use your available benefits before the year ends, they will not roll over. In order to avoid losing out on your benefits, you should diligently schedule two preventive appointments each year. If your dentist recommends any restorative treatment, try to get it done before the year ends. If you need a major service, you might consider splitting it across two calendar years so you can use two annual maximums instead of just one.
Dental insurance does not have to be intimidating! Once you understand the basics, you should be able to navigate virtually any plan.
Meet the Practice
At Wellesley Dental Group, we pride ourselves on providing top-quality care for a reasonable price. We welcome dental insurance, and we are in-network with many popular plans, including those from BlueCross BlueShield, Delta Dental, Cigna, United Concordia, and more. To discover how we can help you navigate your benefits, contact our knowledgeable team at 781-691-4914.