The world of dental insurance is very different from that of medical insurance. If you’re lucky enough to be one of the few people that understand everything about the medical insurance world, you may still be very surprised to find out that dental insurance works in a very different manner. It can be difficult for the staff at a dental office to understand all the ins and outs of a dental plan, let alone the average patient. In this post, I’m going to help you understand how the yearly maximum benefit on your insurance plan works.
The overwhelming majority of dental plans have a yearly maximum benefit. Unlike a medical plan that may give you a very large deductible to meet before they will pay any benefit, dental insurance plans typically give you a very small deductible (if any) before they will pay, but then cap your benefit at a certain dollar amount for the year. Think of this “yearly maximum benefit” as a bank account you’re given for dental. Typical yearly maximum amounts are $1,000.00, $1,500.00, or $2,000.00 per patient, per year. Once your insurance has paid the maximum allowed amount by your plan for the year – they will not pay any more until your plan renews.
Most plans renew on a calendar year basis on January 1st, but a few work on a benefit year set by the “group”, or employer your insurance is through. An example of a benefit year plan would be one that runs October 1st to September 30th, with the plan maximum renewing on October 1st.
When planning your dental treatment, it is very important to understand when your plan renews and for how much, so that we can help you maximize your dental benefit. Also remember that even if your dental plan covers preventive treatment at 100%, in most cases those services will deduct from your available yearly maximum benefit. So, if you have a cleaning and exam with the doctor for $150.00 and the insurance pays $150.00 to our office, remember that you will have that much less available of your yearly maximum benefit. For example, if you had $1000.00 available in benefit, following the payment from the insurance to us for the exam and cleaning, you would now have $850.00 remaining for the year to use toward other dental treatment.
At White Dental Studio, we try our very best to help you understand and maximize your dental benefit. If you have any questions regarding your dental plan, don’t be afraid to reach out. With thousands of plans out there, the answer may not always be immediately known, but we are happy to research your question and assist you as quickly as possible.
Written by: Erin, Office Manger at White Dental Studio located in Ashland, OR
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