Use It Or Lose It: Guide for Getting the Most Out of Your Dental Benefits Before the End of the Year

According to the National Association of Dental Plans, only 2.8% of people with Preferred Provider Organization (PPO) Dental Plan reach or exceed their annual plan’s maximum. That is an alarmingly low number. The National Association of Dental Plans states that roughly 64% of the population has dental coverage.

If your dental plan is on a calendar year, the plan resets on January 1, 2019. If you do not use up the amount in your plan, the maximum does not roll over and you lose it. This means that whatever money you have not used in your plan before December 31, 2018, you are eligible to use before the end of the year.

There are two types of dental insurances that you can either buy privately or your company provides for you through their benefit plan.

  • HMO gives you access to certain dentists and dentist office within its network. The dentist has to be signed up to be a HMO provider.
  • PPO gives you the opportunity to go to any PPO dentist of your choice. You are not assigned a dentist. The dentist is in contracted rates with insurance companies, therefore, this plan offers a balance of lowered cost fees and you typically pay a certain percentage of the reduced rate. The plan pays the rest.

Additionally, many people also get FSA and HSA benefits. Flexible Spending Accounts (FSA) are accounts set up by employers to allow their employees to obtain reimbursement for various medical expenses. Typically they reimburse employees through paychecks or provide them with a debit card that is strictly just used for medical purposes. Health Savings Account (HSA) are funds you withdraw tax-free from your paycheck when used to pay for qualified medical expenses.

On average, most dental plans provide the patient with an average of $1,000 of maximum spending per the calendar year. They typically cover preventative work at a 100 percent. Basic work at 80 percent and major work at 50 percent. That said, it is important to know and understand your specific dental plan and what it offers.

Tips For Using Your Dental Plan

  • Preventative Care
    • Most dental insurance companies will cover this at 100 percent
    • Allows two routine check-ups and cleanings per year
    • Get the work done to prevent cavities or other dental work
    • Many include bitewings and x-rays
    • Does not use deductible or co-pay
  • Basic Work/Major Work (Large Treatments)
    • Have to pay a deductible – if you paid it for that year, why pay it again next year
    • Plan pays for most of the work, but could change the following year
    • Basic work includes fillings for cavities
    • Major work includes crownsroot canals, and bridges (does not include cosmetic dentistry)
  • Plan Could Change Following Year
    • If your employer gets a different insurance company the following year, your coverage, deductibles and maximums can change
    • Insurance companies can change the negotiated fees due to cost of living, equipment, and materials needed
  • Dental Problems Can Worsen
    • Have a cavity? This can turn into a root canal
    • Chipped tooth turns into a cracked tooth that leads to pain and requires a crown
    • If you wait last minute to seek treatment, dentist could be booked through the holidays or the office will be closed
  • Start Thinking of Coverage Early
    • Talk to your dentist about treatments they recommend throughout the year. This way you can budget and plan out your FSA, or HSA.
    • Make your your checkup early in the year, this way any major work can be caught and fixed before it worsens

Talk to your local Jefferson Dental office about your dental plan. They will consult and advise you on the best way to use your plan for the calendar year. If you are unclear on how your plan works, or what your benefits entail, our staff will always contact the insurance company about the break down of your plan’s benefits. Your employer will have copies of your plan as well.

Always plan carefully; do not forget to include routine check-ups (they are free after all), cleanings, and back-to-school visits. Make sure to schedule your six-month routine check-up while at the dentist to ensure you do not forget or skip it. Also, if you wait last minute and book it in December, there is a good chance your dentist will be booked for the remainder of the year.

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