Dental benefits are designed to save you money. If you understand your dental plan, you are better equipped to save money and maintain good oral health!
Delta Dental plans often cover 100% of routine preventive and diagnostic care. This includes procedures like cleanings, exams, and x-rays because we believe in the power of preventive care. When we maintain our preventive care appointments, our dentist can ensure we’re less likely to need restorative dental care procedures down the line.
Let’s review when visits to the dentist may end up costing you money out-of-pocket and how that fits into the cost of dental benefits.
1. Your dental plan has a deductible
With dental coverage, you may sometimes pay money“out-of-pocket.” That means when you receive dental care, you have to contribute a certain amount each year before your plan begins to pay for covered dental treatment costs.
In other words, you must pay for your dental care until your plan’s deductible is met unless it’s something 100% covered by your plan. The good news is, you only have to meet your deductible once in a plan year.
Preventive care services like cleanings are usually covered at 100%, even if your deductible hasn’t been met yet.
2. Your dental plan doesn’t cover 100% of the dental work you need
After your deductible is met, your benefits company will pay for a percentage of treatment. You, the member, may also be required to pay the remaining balance after the insurer pays their percentage of the cost. This is known as “coinsurance.” Paying money out-of-pocket for coinsurance will not start until you’ve met the required deductible, so you won’t be paying both at the same time.
If your dentist comes across tooth decay or signs of a cavity and recommends a filling, root canal, or tooth extraction, DDID usually covers up to 80% of these services. That means Delta Dental pays the majority of the cost, leaving you with 20% to pay. The 80/20 split between you and your dental benefits provider is “coinsurance.”
3. Your treatment requires a copay or copayment
When you choose your dental plan, you should note if there are copayments or copays required. These are fees required after dental services are performed. All copays are a fixed dollar amount that won’t change depending on the cost of the dental work you receive.
4. You hit your annual maximum and still have a treatment scheduled in that plan year
Many dental plans have an annual dollar maximum. This is the maximum dollar amount that a dental insurance provider will pay toward treatment during one plan year. For example, your plan states that your annual maximum is $1,000 and, in one plan year, you had three restorative dental procedures that totaled $1,300. Because you exceeded your annual maximum by $300, you are responsible for paying the remaining $300.
Once the plan year resets, your annual maximum does, too. (Click here to sign in to our member portal to review your plan details.)
5. Your treatment isn’t covered by your plan
Dental coverage depends on your plan’s specific design, and not all plans cover all treatments!
If you want to have veneers put on your teeth or a special whitening treatment is done, these would most likely be considered cosmetic services. Cosmetic dental procedures focus on improving the appearance of a person’s mouth rather than providing preventive care. Cosmetic services probably aren’t covered by your dental benefits plan, so you’d have to pay the total cost.
Here are some ways you can save on the cost of dental benefits:
- Visit in-network dentists.
- Keep up with your preventive care appointments.
- Keep an eye on your deductible and annual maximum as the year goes on.
Since preventive care is almost always covered at 100%, make sure you’re scheduling your appointments as often as your plan allows to maximize your benefits.
Click here to learn more about preventive care.