How much do you actually know about your dental insurance? If you’re like most people, the last time you looked at your plan was when you purchased it, or you may have never really gotten into the details if it comes from your employer.
While every plan has a lot of information, there are 4 important facts you should know above all else to guarantee you make the most of your coverage at each dental visit.
1. Yearly Maximum
Every dental insurance plan has a yearly maximum, which is the highest amount a provider will pay out for dental care for an individual each year. The range is typically about $1,000-$1,500. Any dental expenses beyond this amount are solely the responsibility of the patient.
Keeping this in mind can help you and your dentist know how to schedule your treatment so you stay within your maximum.
2. Your Coverage Resets Every Year
This yearly maximum along with any fully covered services (such as checkups and cleanings) resets each year—either on January 1st or 12 months after you started the plan.
This means if you have $500 left on your yearly maximum for 2024, you will not be able to use it in 2025, as coverage does not roll over. The current estimation is that people in the U.S. leave about $100 billion in unspent dental benefits every year!
3. In-Network vs. Out-of-Network
If a dentist is in-network with your dental insurance provider, that means they have a contract with them to offer their services at set prices. With an out-of-network dentist, they have more flexibility in what they can charge and the types of treatments they offer.
Sometimes, the price difference between visiting an in-network dentist versus an out-of-network one is significant, but it can often be negligible as well. It’s important to talk to a practice’s team so they can give you an estimate of your costs and coverage before you commit to treatment.
4. Plans Change
While you’re certainly aware that your dental insurance premiums change on a yearly basis, many people aren’t aware that the terms of their coverage change as well. Every year, the amount of money a plan will pay for certain procedures can shift, as can which procedures are even covered in the first place.
This is why it’s important to work with your dental team each time you want to use your insurance–just because something was covered last year doesn’t mean it will be this year.
By knowing these 4 facts, you can add more certainty and transparency to the process of paying for your dental care. Thankfully, you don’t have to parse through your policy alone—you can always talk to your provider, or better yet, your dental team. They deal with this stuff every day, so they’ll be able to give you the definitive answers and advice that help you enjoy peace of mind.
About the Practice
Northern Virginia Oral, Maxillofacial, and Implant Surgery features a team of specialists who are proud to provide advanced services to our community. We are in-network with several popular insurance plans, and we are always happy to help patients understand how their benefits apply. To learn more about how we may be able to serve you, contact any of our three conveniently located offices in Alexandria, Reston, or Burke.