We always recommend that our patients understand their insurance benefits, and our Sunnyvale dental office will go the extra mile to help you understand your insurance benefits.
Many of my friends are trying to select insurance plans for the new year and are deciding how much money to allocate to their HSA/FSA for the new year. Some of them have also realized that there are only a few weeks left in the year to use their dental insurance benefits.
If this is your employer's open enrollment period and you are deciding between several dental insurance plans, here are a few things to consider:
What does insurance consider a "year"?
Many insurance plans are a calendar year benefit. This means your insurance benefits are paid January 1 through December 31. Your insurance renews itself on January 1, and your benefit year ends on December 31.
Some other insurance plans run on a different benefit cycle. For example, many of our patients who work for Amazon have plans that run from April 1, 2020 through March 31, 2021.
Insurance plans are "use it or lose it" - which means if you don't use your insurance benefits, you will lose them for the year. Most plans do not have a "rollover" option.
What are your yearly benefits? And what is a deductible?
Most insurance plans have a maximum amount that they will pay each benefit year. Any expected costs beyond this amount are your responsibility, regardless of your insurance coverage. In the Sunnyvale region and the greater Bay Area, many insurance plans range from $1000-5000 per year. This means your insurance will pay up to this set amount per year.
Additionally, most insurance plans have a deductible that needs to be paid once per benefit year before insurance companies will help you with your treatment costs. While deductible costs vary per plan, most deductibles for our Sunnyvale patients run between $25-75.
This is especially important to patients who seek treatment near the end of the year. If you needed two different appointments for treatment but scheduled them both in different benefit years, you would need to pay the deductible twice. Many of our patients allow themselves ample time to schedule their treatment in the same benefit year, thus eliminating the need to pay a deductible twice.
How much does insurance pay? What is my expected cost for treatment?
Many insurance companies will only pay for a percentage of your treatment fees. While most preventative dental visits (such as exams, x-rays, and cleanings) are usually covered in full, many other procedures are not.
It is common for insurance companies to pay a percentage (and oftentimes it is a large percentage) of treatment costs associated with fillings, root canals, deep cleanings, and extractions. Insurance companies usually pay a smaller percentage of treatment costs associated with crowns, bridges, and implants. And I know what you may be thinking next - usually, insurance companies do not cover cosmetic work, such as veneers or whitening.
However, each insurance plan is different, and many dental insurance plans have loopholes and conditions that limit what they will help pay for, which is why...
It is important that you understand your dental insurance benefits. It is important that your dentist and dental home understand your dental insurance benefits.
We ask all patients provide us with their updated insurance information prior to their visits with us. We check your insurance benefits for you ahead of time and have it ready for you during your visit with us.
Our team will prepare a detailed pre-treatment estimate and review this with you so that you understand your insurance benefits. If you have questions regarding your teeth and oral health, and are wondering how your insurance benefits may help you, schedule an appointment with us today!