Preventive care is what we do to keep our bodies healthy. Preventive dental care helps us maintain the health of our mouths as we work to avoid tooth decay, tooth loss, and other harmful issues. Biannual dental visits are encouraged because they help prevent problems in the mouth from occurring. When your dentist catches cavities and decay early on, they can stop them from getting worse. This reduces your chance of needing complex dental work down the road. It also helps your dentist see any changes in your mouth when you return six months later for your next appointment! Did you know your dental benefits are based around preventive care? When you understand what preventive care is, you can better understand how to put your dental benefits to use.
Understand your dental benefits by getting familiar with how they work:
How Preventive Care Works with Your Dental Coverage
Because we believe in the importance of dental care, Delta Dental of Idaho plans usually cover 100% of routine preventive and diagnostic care. This includes preventive procedures like cleanings, exams, and x-rays.
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 the cost. That means Delta Dental pays the majority, leaving you with only 20% to pay. Click here to learn more about your dental plan’s coverage.
*Be aware that a deductible — the amount you pay before your dental insurance kicks in — may apply to these services. Your deductible will depend on your specific plan design.
What is a Deductible?
The amount of money a member agrees to pay before Delta Dental of Idaho starts to pick up the tab is called your “deductible.” You must pay for your dental care until your plan’s deductible is met. However, you only have to meet your deductible once in a plan year.
Deductibles don’t apply to regular exams, x-rays, and cleanings. Preventive care services like cleanings are usually covered 100% from the start (depending on your benefits plan), even if your deductible hasn’t been met yet.
A dental claim is created when you get a dental procedure done. It’s a document that outlines the procedures that were performed while you were at the dentist. This document is sent to your insurance provider, Delta Dental of Idaho. Our team members review the claim and ensure your benefits are applied correctly to the procedures.
What is Coinsurance? What is Copay?
Coinsurance and copays are how you share the cost of dental procedures after you’ve met your deductible. A copay is a fixed dollar amount, like $20. Coinsurance, on the other hand, is usually a paid percentage.
With a copay, you’ll always pay the fixed amount no matter how much the total cost of your appointment was. As a percentage, coinsurance changes depending on the total cost of the dentist.
What is a Dental Plan’s Annual Maximum?
This refers to the maximum amount of money your plan will pay for dental services in your plan year. If your plan is based on the calendar year, then the time frame for your annual maximum is from January to December.
If you reach your annual maximum in August, you will have to pay for dental procedures without sharing the cost with Delta Dental until your plan year starts over the following January.
What is a Dental Benefits Premium?
This is the fee paid for your dental plan, which is usually a monthly charge. If your benefits are given to you through your employer, they likely pay either part or all of the dental insurance premium.
Broaden your understanding of dental benefits basics with our Dental Insurance 101 post.