Dental Insurance is very confusing and somestimes downright baffling. It is not at all like Medical Insurance and those of you that have your Medical Insurance down I want to applaud you and send well wishes because it's the usual reason is that you or a loved one is chronically Ill and you needed to learn the language of Medical Insurances.
Dental Insurance is very confusing and sometimes downright baffling. It is not at all like Medical Insurance and those of you that have your Medical Insurance down I want to applaud you and send well wishes because it's the usual reason is that you or a loved one is chronically Ill and you needed to learn the language of Medical Insurances.
Dental Insurance is vastly different than Medical. Dental Insurance has slowly evolved over the past 30 years, some have remained shocking very similar to what they offered 30 years ago. I have broken down a few ways to get dental Insurance:
- A lot of Unions will dictate what they will offer as Dental Insurance.
- Teachers (Union and nonUnion) are split down the middle. Some will offer a big brand Insurance like MetLife and some will make up their insurance policy.
- Most bigger businesses offer the "Stock" Insurance ( Whatever their HR finds that is cheap and works for their business).
- Smaller businesses either don't offer Insurance or they will offer through their HR Department (Whoever runs the paychecks) in that case, you or offered a few options that you can choose from.
- If you are looking on the Marketplace. Dental is usually wrapped with Vision when you are selecting a Medical plan.
Most Insurances are based on a Calendar year (January - December), which means benefits start in January ( usually $1000-$3000 depending on what plan you have) and renew in the following January. Whatever you haven't used gets discarded. There are plans that have Rollover options where a small amount (anywhere from $500-$750) gets rolled over in addition to your new benefits. These rollover benefits can be cumulative or used first in the new year, depending on your plan. It's always a good idea to know how your plan works for you.
Now if you don't work for a Union, or have absolutely fabulous insurance ( like most of us ) our insurance does not pay at 100% all of the time. Most dental benefits are paid on a percentage rate:
- Anything diagnostic and preventive procedures
- Anything that is a "Basic" procedures (like fillings, sometimes Periodontal work, Endodontic work like root canals)
- Anything that is "Major" procedures (like crowns and bridges, Extractions and Oral surgery, dentures)
- Implants are either covered or not and often at a percentage (usually 50-60%)
- Nightguards are either covered or not and often at a percentage (usually 50-60%)
- Orthodontics are a separate coverage with a lifetime benefit. There are many stipulations that come with Orthodontics: Age, does family get the same benefits as the subscriber? ( sometimes it's just the kids, sometimes it's just the member, sometimes it's the whole family), Have you used the benefit before? This benefit is often given at a percentage as well 80-50%.
Now if you think about it, if you are the type of person that only needs cleanings, exams and X-rays every 6 months you are using about $200-$400 a year of your benefits. If your mouth is a mess and need a crown or root canal every year, or even max out every year, then you definitely use your benefits to the best of your ability.
But time and time again, I hear several misconceptions. Here are a few:
- " I want to wait until next year" - While there are some reasons that it is a good idea to wait until next year to take advantage of your new benefits, don't forget to completely utilize the current year's benefit's first. Just because you think your out of pocket may be cheaper, doesn't mean you may be paying for more work because you waited on treatment.
- "Isn't my cleaning free?" -No, Dental exams, cleanings, and X-rays are typically covered at 100% by your insurance, just as long as you have benefits remaining. No benefits, no "free cleaning"
- " I don't know how I can pay for that!" - The great part of Dental care and Dental treatment now is there are so many ways to pay for it. With us, Dr Steven Talerman, in Roslyn we offer a variety of payment options for you.
- Cash, up front. we offer a 20% discount for Cash upfront
- Check, Credit or Debit Card
- Depending on your treatment we may be able to break your payment into 2-3 payments
- Care Credit, Which is like a Medical Credit Card. The best part about this Credit Card is that you can pay off your balance within 12 month interest free or spread out your payments for up to 5 years
With so many options today. There really isn't any reason to let your benefit go to waist if you need treatment. Make an appointment today before your Benefits run out!