Understanding insurance can be tricky, with all the types of coverage options and discussions about annual limits and deductibles that can leave you feeling overwhelmed at times! However with some planning and a good grasp of the basics you can maximize your insurance benefits and maybe even cut down on costs while you’re at it! Here’s a breakdown on how to achieve that.
- Understanding the Extent of Your Insurance Coverage.
One of the tasks when dealing with your insurance is understanding the specific coverage details provided by your plan, which typically categorize coverage into four primary areas:
Routine Care:
Routine dental care typically consists of cleanings and examinations along with x-rays which are commonly fully covered by insurance plans without any out of pocket costs, for maintaining your oral health.
Basic Procedures:
Basic procedures, like fillings and extractions typically cover around 70 to 80 percent of these expenses and are reimbursed by your insurance plan. But you may still need to contribute a bit of money towards the cost.
Major Procedures:
This category includes crowns, bridges, dentures and similar treatments. Insurance usually covers around half of the cost, which can be quite beneficial given that these procedures can be costly.
Make sure to review the details of your insurance plan and request pre-determinations before any procedures to avoid surprises when the bill comes! It’s always wise to give your insurance company a call, for any clarifications you may need.
2. Understanding Your Yearly Maximum is Essential
One key thing you need to keep in mind is your yearly limit. This is the amount your insurance covers for treatments annually. Once you surpass that threshold any extra expenses will be your responsibility. Typically most policies cap the maximum at, around $1,000 to $2,000. It’s advisable to monitor this number throughout the year.
Your out of pocket deductible plays a key role in your insurance coverage, this represents the amount you must pay before your insurance provider kicks in to cover expenses for you.
3. Preventative Care
Getting check ups and cleanings are typically covered by your insurance at no cost to you. Skipping these appointments might seem convenient at the moment but they could result in costly problems, in the long run. Early detection of issues can lead to invasive and cheaper treatments later on.
Make sure to go for those cleanings offered by your insurance company twice a year. It’s a win-win situation, for your finances as well as your oral health.
4. Plan Major Procedures Smartly
If you find yourself in need of a major dental procedure such, as a crown or root canal that requires substantial investment of time and money, be sure to take into account the timing in a way that works within the framework of your insurance benefits resetting annually. This allows you to manage your treatments strategically by spreading them out over time to make the most of your coverage limit for each year.
For instance, if you have two treatments scheduled. Consider scheduling one, towards the end of this year. The other at the beginning of year after to make the most of your benefits without facing high, out of pocket expenses all at once.
5. Leverage the Benefits of Having Insurance Policies to Your Advantage
If you happen to be fortunate enough to be enrolled in two insurance plans like receiving coverage through your workplace as well as your spouse’s plan. You can benefit from coordination of benefits (COB). Essentially, the primary insurance plan will take care of expenses while the secondary plan will pitch in to cover any remaining costs.
It’s a strategy to reduce costs; make sure to inquire with both insurance companies about how coordination of benefits (COBs) interacts with your policies.
6. Pay Attention to Your Explanation of Benefits (EOB)
Whenever you have an appointment and your insurance provider sends you an Explanation of Benefits (EOB) be sure to take a look at it instead of disregarding it right away—it’s important to review it carefully! Mistakes can happen but identifying them sooner, than later can prevent potential issues and can save you money.
If you notice something that seems off or incorrect in your bill statement or coverage details, you should reach out to your insurance company for clarification and resolution before any charges arise
7. Consider exploring a Health Savings Account (HSA) or a Flexible Spending Account (FSA).
If your dental insurance doesn’t pay for all expenses incurred in treatment processes or procedures; you might want to think about utilizing a Health Savings Account (HSA) or a Flexible Spending Account (FSA). These accounts allow you to allocate tax funds for medical and dental costs. Enabling you to use the funds to offset expenses that are not covered by your insurance plan.
When you use money before taxes are taken out of it for healthcare expenses, like this one in question is essentially rewarding you with savings on what you pay from your pocket for medical care costs. Additionally, having a Health Savings Account (HSA) or Flexible Spending Account (FSA) can serve as a safety net, for those procedures not completely covered by your insurance plan.
8. Make Sure to Keep Yourself Informed About Your Plan at all Times.
Insurance policies are not permanent; they can change annually. The suggestion is to check your policy every year during enrollment to stay informed of any modifications to coverage details, like premiums and deductibles.
Stay up to date with the information so you can make the most of your insurance coverage and steer clear of any surprise expenses.
To conclude, navigating insurance may seem complex at glance; however with some knowledge and attention to detail, there are several strategies to make the most of your coverage and cut costs effectively. Be proactive, about scheduling treatments, approach procedures thoughtfully and always get a predetermination for dental surgeries. Additionally, if you have insurance plans, leverage coordination of benefits to optimize your savings. By investing time and energy into these steps, you can maintain a smile while keeping your finances in a great position.
To learn about our dental services and sedation options, or to schedule an appointment with our dental care specialists in Hamilton, call Downtown Sleep Dentistry & Oral Surgery at 289-272-8696 or contact us here.
