Dental insurance is normally a great thing. Otherwise, you’d have to pay every dime of expensive treatments and visits. But sometimes, it’s like they are from another planet. What does “coinsurance” mean? Why is one treatment covered and another not? All of that can drive you crazy. To help, here are some tips to stay sane while enjoying the benefits of dental insurance.
Find out if you have a waiting period for any treatments. The point of insurance is to pay into it for a while, then draw on it when you need help. It’s not a discount plan where you can pay one month’s premium, use it to save money, and then drop it. Many people try to do exactly that. To fight it, many insurance companies have a waiting period for certain treatments. You can’t get it paid for until a certain time has passed such as a year. This stops people from realizing they need a tooth extraction and suddenly realizing they need insurance.
If you are new to your insurance plan, check with the company to see if any treatments fall into a waiting period. You would hate to get a dental crown procedure only to find out the company won’t pay for it.
Know the differences between copay and coinsurance. These two sound alike but are very different. A “copay” is an amount you pay when you show up to our Nashua, NH dental office. For example, if your copy is $20, then you would have to pay $20 at your visit. Copays are usually paid instead of the usual doctor’s visit charge. That $20 copay won’t cover the cost of extra treatments.
Coinsurance is the percentage you have to pay for treatments. If your coinsurance is 20%, you would have to pay 20% of the cost for a treatment like dental implants or sleep apnea devices.
Can you have to pay your copay and coinsurance at the same time? Yes. Let’s say you visit one of our dentists for a dental crown. The office visit would likely be your copay, and the cost of the crown itself would be your coinsurance.
Check to see how much preventive care is free each year. Dental insurance companies are usually smart. They realize that preventive care can help you avoid complicated (and expensive) treatments down the road. Many companies will pay 100% of costs for preventive care like exams, cleanings, and X-rays. However, there are limits. They would end up paying a lot more if you could get a cleaning every month. See what preventive care is covered and how many they will cover each year.
Know your deductible and if it does not apply to certain treatments. Deductibles are another way for insurance companies to control their cost. It also keeps premiums lower by moving some of the costs to people who use the insurance. Your deductible usually has to be met in full before any insurance kicks in. If your deductible is $1000 and you get $600 worth of treatment, you’re responsible for that $600.
However, some treatments (like preventive care) can be exempt. That means your insurance applies for those even if you haven’t met your deductible. For example, many HMO plans require a copay for office visits, but they do not fall into your deductible. Only your insurance company will know for sure.
Be aware that your insurance company year might not be everyone else’s year. Insurance companies have a benefit period. Normally, this is a 12-month time when your insurance is valid. That makes sense; you only get to use insurance if it’s valid. However, not every company uses the same 12-month period. For some, it’s the calendar year. For others, it’s 12 months after you start paying. Still others use a fiscal year.
Why is that important? Because your deductible and preventive care limits are based on your benefit period. If your deductible starts over again each benefit period, is that January 1st, June 1st, or what? That can make a big difference when planning dental treatments.
Stay in your network. These days, almost every dental insurance plan has a group of dentists called a network. To help lower costs, an insurance company asks a dentist to charge less. In return, the company encourages its customers to go to that dentist or face a higher coinsurance or copay. When you get a group of dentists to all agree to that, it’s called a network. (It can also be called a provider network.) If you want to avoid paying a lot of money, stick to dentists in your network.
Your insurance company is usually the best people to contact if you have any questions. However, your dentists in Nashua, NH will do everything they can to help. If you are ready to schedule an appointment, call us today at 603-546-7460.