Deductibles? Maximums? Copays? Dental insurance can be a little confusing at times. (OK, a LOT confusing.) To help clear up any befuddlement you may have about your plan, here are five things you might not know about your dental insurance.
1. Dental benefit plans aren’t exactly insurance.
According to the American Dental Association, “dental benefit plans are not really insurance in the traditional sense but are designed to provide you with assistance in paying for your dental care.” Dental benefit plans may require you to choose a dentist from a list of preferred provider organizations (PPOs), may have limitations on your number of office visits, and may not cover pre-existing conditions. Talk to your plan provider or employer to get the full description of your dental benefits plan.
2. FSA v. HSA? There’s a difference.
Do you have an FSA or an HSA, and do you know how well you’ll be covered during a dental emergency? Serving as the most common insurance type in the workplace, a flexible spending account (FSA) allows you to use up to $2,550 of pretax dollars to pay for medical expenses, with the money withheld from your paycheck. By using a health savings account (HSA), you can save up to $3,350 a year for individual medical expenses or $6,750 for family medical expenses ($4,350 if you’re 55 or older). Unused money continues to roll over indefinitely and can be used for health care expenses in retirement. These accounts have different pros and cons, so make sure you know how your particular account works before a dental issue arises.
3. Cosmetic procedures aren’t typically covered.
Procedures such as teeth shaping, teeth whitening, and veneers are not usually covered by insurance policies. Because these procedures serve to improve the appearance of teeth, they are not considered “medically necessary,” and will most likely need to be paid for out-of-pocket.
While the Affordable Care Act requires plans to provide dental insurance for children under the age of 19, children’s braces are normally classified as cosmetic orthodontics. Coverage varies from plan to plan, but most policies do not assist with the cost of braces (unless the case is severe enough to meet specific criteria).
4. Watch out for waiting periods.
To ensure that they profit off of new accounts, most insurance companies uphold waiting periods of six to 12 months. Standard dental work won’t be covered during that time, and major dental work may even require a longer waiting period. If you’re new to your plan, make sure you know how long your waiting period will last.