January 2019: Insurance Benefits 101
Our Garners Ferry Dentistry team gets a lot of questions all the time about insurance benefits. We understand how tricky things may be when it comes to your plan. Typically benefits are arranged as such:
- Preventative Services. 80 – 100% paid by insurance (patient pays little to nothing out of pocket). These services include exams, x-rays and cleanings (non-periodontal). Most plans will cover these services two times (2X) per year.
- Basic Services:* 50 – 80% paid by insurance (patient pays remaining portion – “co-insurance”). These services include filings, extractions and periodontal treatments. Typically, periodontal treatments are covered by insurance two to four times annually.
- Major Services:* 35 – 60% paid by insurance (patient pays remaining portion). These include crowns, dentures and orthodontics. Crowns and dentures are usually covered every five (5) years and some plans have a lifetime orthodontic maximum benefit.
*These services typically have one-time deductible that is paid once by you annually.
After the deductible is paid, plans normally pay up to a certain maximum benefit amount of $1000 – $2500 annually although you will have to pay co-insurance along the way.
However, plans are normally designed to encourage you to see a dentist periodically which is why most preventive services are fully covered. Insurance companies want their members to take care of issues before they become more complex and expensive.
Most plans renew January 1 of each year. If you receive dental insurance through your employer, you will typically get all of your benefits at this renewal date. This could be thousands of dollars that can be used immediately. Your full dental benefits may be available up until the time you leave your employer.
The longer you wait to take care of dental issues, the more likely you will incur greater cost and time away from work, leisure and family. Note that all insurance plans are different, and our Columbia, SC dentist and support staff can guide you through your plan and maximize your benefits. Contact us today to take advantage of your what your plans pays.
