5 Tips to Maximize Your Dental Insurance Coverage

Dental Insurance Coverage

When you sign up for a dental insurance coverage plan, it’s with the expectations that it will be an invaluable weapon in your battle against dental problems. However, a surprising number of Americans end each year without having meaningfully utilized their dental care plan. And it’s often not because they don’t need it. Rather, it’s a weak understanding of what is available to them. It doesn’t help that insurance plan documentation is peppered with terms that the average person isn’t necessarily familiar with. 

Your dentist is a great resource in helping you know what is available to you. Nevertheless, your ability to harness the full power of your dental insurance plan comes down to you. Use these tips to get your dental insurance plan working in your favor. Below are 5 Tips to Maximize Your Dental Insurance Coverage.

1.    Attend Dental Exams and Cleanings Religiously

The cheapest way to ensure your oral health is always in great condition is to visit your dentist regularly for a dental exam and cleaning. Ideally, this should happen at least twice each year. These services are often 100% covered by HMO plans and 80-100% by PPO plans

Once you get into this routine, you will realize that problems are detected in good time and therefore don’t require expensive procedures to resolve. Follow your dentist’s tips on maintaining good oral health, preventing cavities and reversing gum disease.

2.    Know the Annual Limits

Virtually every dental insurance plan has an annual maximum. This is the total amount the plan can pay for each year. 

If you’ve previously used your dental insurance plan over the said year, you can get in touch with the insurer to establish what amount remains available. Do this before getting booked for any extensive dental treatment. If your dentist files a claim that is denied because you have already reached the maximum of your plan for the year, you’ll have to pay the outstanding amount out-of-pocket.

Your plan will also limit the number of dentist visits, dental cleanings and dental x-rays that can be carried out each year. Also, a visit to a dental specialist is billed differently from a visit to your regular dentist. Understand these limitations before you commit yourself to any procedure.

3.    Request Predetermination of Benefits

Predetermination of Benefits

One of the key reasons dental care is omitted from many standard healthcare plans is that it’s perceived as cosmetic in nature as opposed to life-saving. It does make sense since the overwhelming majority of dental work wouldn’t be considered an emergency. There will be a sizable time window between when the dentist recommends a procedure to when it actually occurs. 

You could therefore request your dentist to send the insurance company a ‘predetermination’ of benefits before they proceed with treatment. The insurer will process an estimate in much the same way it would a claim. The difference is, in this case, the insurance company sends a statement indicating what they would have paid for. 

Doing this eliminates surprises and gives you the confidence to plan your dental treatment with ease. It’s also a great way to know whether your plan has a least expensive alternative treatment (LEAT) that rules out covering certain forms of dental treatment.

4.    Plan Multi-Stage Treatment Accordingly

Your annual maximum doesn’t carry over to the next year. Rather, it renews at the start of each year. Ergo, if you are planning on undergoing extensive dental care treatment, you can schedule the stages in a way that maximizes your plan payments. 

The best approach is to arrange the treatment stages in a way that your plan’s annual maximum renews somewhere between stages. This will ensure that your plan adequately covers the next treatment stage while leaving sufficient room to accommodate emergency unforeseen dental treatment for the rest of the year. 

So if it’s November and you are already approaching your annual maximum cover, request the dentist to put off the next stage treatment until January or February.

5.    Get Creative

Get Creative

Despite your best research, planning and care, you may still end up with unreimbursed expenses following a dental procedure. Nevertheless, just because your plan doesn’t cover certain expenses doesn’t necessarily mean you are out of options. In some cases, the government or your employer might just be able to pick up the slack. 

For example, you might be eligible for a voluntary salary reduction through your employer in tandem with the value of unreimbursed expenses for your plan then have the reduced amount reimbursed tax-free. Consult an accountant or tax attorney for details and advice on any state-specific options you have at your disposal.

You deserve the best of what your dental insurance coverage plan has to offer. You are paying for it after all. Apply these tips to make your dental insurance premiums count.


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