How To Maximize Your Dental Insurance Before It Expires
How To Maximize Your Dental Insurance Before It Expires
With the winter holidays around the corner, it also means that we are nearing the end of the year – when most dental insurance plans renew to a new set of benefits for 2025. One question we get very frequently this time of year is how patients can maximize the benefit of their dental insurance. But dental insurance can be confusing, with terms like annual maximum, coverage percentages, basic versus major procedures, deductibles, and lifetime maximums – it’s ok to feel that it's very difficult to understand and navigate your plan. Read on if you want some guidance and tips on various scenarios to maximize your dental insurance benefits!
Simply put, if your dental insurance renews on January 1st, like most plans, your “annual maximum” is also resetting. This means any unused amount in 2024 is lost when the 2025 annual maximum is refreshed on January 1st. We recommend checking to confirm your insurance does renew at this time, as we have seen some plans renew in March, June, or October.
With most patients looking to maximize their benefits usage, it comes down to this concept of “use it or lose it” before the end of the year. Of course, only preventative and restorative – clinically appropriate procedures are covered with dental insurance. Therefore, voluntary procedures like teeth whitening, cosmetic veneers, etc.. would not usually be eligible for insurance benefits in these scenarios. Therefore, it is essential to consider if you have any outstanding dental procedures recommended by your Winter Park dentist or any overdue preventative care like a checkup and cleaning.
Typically, the annual maximum of insurance is round numbers like $1000, $1500, or $2000. Based on the Winter Park dental office estimate of insurance usage for your recommended treatment, you may have more treatment necessary than would be covered in a single year. In these cases, it can be beneficial to have some treatment performed before the end of the year and have next year’s annual maximum cover the remaining treatment.
While your insurance has additional limitations and considerations, such as deductibles and frequency limitations, we can discuss those in specific scenarios.
When should I perform some treatment before the end of the year?
If you have treatment that may not be covered entirely by a single year’s annual maximum, such as a root canal and a crown, splitting those treatments up across the two years may be favorable. For example, if your insurance has an annual maximum of $1000, but the root canal and crown would use a total of $1200 of your insurance if performed in the same year, that might mean an additional $200 out-of-pocket cost. However, if the timing works out and does not put you at an additional risk, you can consider having the root canal procedure performed before the end of the year and the crown in the new year. In this example, the root canal may use up $700 of your $1000 annual maximum this year – and the crown uses up $500 of your maximum for next year. While you will likely still have a copay (because insurance plans typically still dictate a 20% patient copay for root canals and a 50% patient copay for crowns), it minimizes any excess cost you might incur in a year. It is important to note that in this example, the exact timing will matter as root canal procedures that need a follow-up crown are typically recommended to be performed within 30 days of a root canal procedure. Going longer than this may present more risk to the tooth as it is not fully protected.
What if I don’t need more treatment than my annual max can cover?
If you don’t need more treatment than your maximum – that is great! However, there may still be scenarios where you want to avoid excess costs and maximize your benefits. The most common scenario is if you have basic restorative procedures, like dental fillings, which require a deductible payment upfront for your insurance policy. A simple example would be if you have two fillings to be performed in 2 separate appointments. You may have already completed one filling but are considering when to schedule the 2nd appointment for the second filling. In this situation, you would have already paid your annual deductible (typically $50) on the first appointment. This means that if you have the 2nd filling performed before the end of the year, you will not be paying the $50 deductible again. If you were to wait until the new year, your out-of-pocket cost would be $50 more because the deductible will reset. So, in this situation, it may be beneficial to minimize your out-of-pocket cost by having the last filling done this year and avoid additional deductibles.
What if I don’t need anything except cleaning?
If you have no necessary restorative work, that’s a good thing. However, you may have missed a scheduled cleaning, or perhaps your insurance offers more than two cleanings a year. In this case, you may want extra preventative work done before the “counter” resets in the new year. For example, if you have already received one of your two cleanings in a year, but it resets in the new year – perhaps you would prefer to have the 2nd cleaning scheduled within this year so that next year you have the same two available to fit your schedule.
In Conclusion
If you need some dental treatment or are unsure, it makes sense to use your insurance this year before it resets into the new year. We can make recommendations on what dental insurance to choose. If you have some unscheduled treatment with our office, please give us a call so we can set up those appointments. It’s a busy time of year, but we try extra hard to squeeze in all our patients who want to maximize their insurance benefits. If you aren’t sure if some procedures would be better to do this year or next – please give us a call or visit us. We’ll be happy to help provide an opinion on how to use your insurance best.