Making the most of your dental insurance

Most people take full advantage of their medical and vision insurance. They know the policy’s limits, coverage, and deductibles. Dental insurance is not usually thought about until the person has a toothache or other dental issue. This thinking usually causes people not to fully take advantage of their dental benefits each year. This behavior also causes dental patients to not understand their plan benefits. It is important to know exactly what your dental benefits are. The easiest way to determine coverage and to understand the applicable deductibles is to call the dental insurance company. They will give you a snapshot and summary of the plan benefits.

As with other forms of insurance, annual deductibles apply to most dental insurance plans. For example, the plan year runs from January 1st, through December 31st. There may be a $100 deductible for the plan year. This means that the first $100 is paid by the patient. Once the $100 deductible is met, then the plan benefits apply. If you have met your deductible in July for example, it is wise to get as much dental work as possible completed before December 31st , as there will be a new $100 deductible come January 1st. Many dentists are motivated to begin major dental treatments at the end of the plan year to take advantage of the fact that the full deductible has already been utilized for that plan year. Some dentist offices review each patient’s file at the end of each year to assist the patient in taking full advantage of their plan benefits before they expire.

Most dental insurance plans have a predetermined number of included services per year. For example, a standard dental plan includes two cleanings per year. If you do not have these cleaning completed by December 31st, you lose them. Other similar services include x-rays and gum treatments. Again, use them or lose them!

Aside from all the great services that you will be losing out on at the end of each plan year, the best reason to use your dental coverage is that it will keep your teeth and gums healthy. The reasoning behind the insurance company offering these services at no cost is to encourage you to get into your dentist’s office on a regular basis. Doing this ensures that cavities and other problems will be caught quickly and not turn into major dental repairs down the road.

It is recommended that each year you develop a strategy for your dental care. First, become the expert on your dental insurance. You should know your plan’s coverage prior to making an appointment with the dentist. And you need to make sure you have an up to date insurance card with the correct plan number on it. Our office staff can only bill for you if we have  the correct information.  This will ensure that you can resolve any coverage misunderstandings with the dental staff quickly. Your dental coverage also consists of more than seeing a general dentist. Most plans cover a visit to the specialist for oral surgery and various conditions of the mouth. Orthodontic coverage is may not be limited to teens and children. If you are unhappy with the appearance of your teeth, learn what types of services are covered under your dental plan. You may be surprised at the amount of coverage you have and the innovative options that exist for orthodontic services. Most patients are not aware that many orthodontic services are considered necessary and not cosmetic procedures.

Second, schedule your routine cleanings and checkups at the beginning of each plan year. Dentists are one of the few professionals that are comfortable scheduling appointments months in advance. Finally, if you believe that you have an issue with your teeth, make an appointment before the issue becomes a full-blown problem. As you are responsible for the deductible, catching problems while they are small will mean less money out of your pocket. We have a vested interest in your teeth. It is our goal to keep your teeth healthy and keep you smiling!


Paul M Gangi DMD