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Dental Insurance 101: What Does Your Plan Cover?

October 6, 2021

Filed under: Uncategorized — carlsondental @ 6:37 pm
woman holding a pink piggy bank and pointing to her smile

You signed up for a dental insurance plan and you’re aware that it’s important, but do you truly understand how it works? Dental insurance benefits can save you quite a bit of money on the care your smile needs, but only if you use them properly! If you want to make the most of the coverage you’re paying for, it’s crucial to know what your plan covers. Read on as a dentist in Jacksonville gives you a basic rundown.

Two Key Terms to Know: Annual Maximums & Deductibles

First and foremost, you have to understand two important dental insurance terms: your annual maximum and your deductible. Your annual maximum is the amount of money that your insurance company will put toward your care in a given period (typically one calendar year).

Before you can access your annual maximum, though, you have to meet your deductible. The deductible is the amount you must pay out-of-pocket before the insurance company steps in and starts covering your treatments. After that, your insurance will pay for your care until you’ve reached your annual maximum.

The 100-80-50 Guideline for Dental Insurance Coverage

Every dental insurance plan is different, but most of them follow a 100-80-50 rule in terms of which types of treatments they’ll cover. You can usually expect them to pay for:

  • 90-100% of preventive and diagnostic care (checkups, cleanings, etc.)
  • 70-80% of basic treatments (gum disease therapy, fillings, etc.)
  • 50-60% of major procedures (dental crowns, root canals, etc.)

Additional Costs You’re Responsible For

In addition to your deductible, you’ll also have a couple of other expenses:

  • Premiums – The monthly, quarterly, or yearly fee you have to pay your insurance company to keep your plan active.
  • Co-pays – Every time you visit your dentist’s office for an appointment, you’ll need to pay a specific amount.

How to Make the Most of Your Dental Insurance Benefits

Now that you understand the basics of dental insurance coverage, the next step is to learn how to maximize your benefits. For the majority of insurance plans, any benefits that remain unused at the end of the year expire when the plan resets. If you currently have some benefits left and you’ve already met your deductible, now is the perfect time of year to get any dental work you need (such as fillings) taken care of. That way, you’ll pay as little as possible for it!

Do you still have questions about how dental insurance works? Feel free to call your dentist. Their team is more than happy to help you navigate the ins and outs of your plan to keep your smile healthy and your wallet full!

About the Practice

At Carlson Dental Group, our dentists have decades of experience in a wide variety of areas of dentistry, allowing families in the Jacksonville area to get all of their oral healthcare needs met under one roof. We’re in-network with many of the country’s leading dental insurance providers, so we’d love to help you save on your care! To learn more about what your dental insurance covers, contact us at 904-262-8409.

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