5 things you should know about your Dental Insurance Plan

Dental Insurance can be a bit overwhelming to navigate. Dr. Guardiola and the Maxwell Creek team have put together a list of five things that you should ask your plan’s administrator about your dental insurance policy.

How much is your monthly premium?

On average most dental plans in the US average $50 per month, but some are as high as $80 per month. This is your cost to participate in the plan and to take advantage of their benefits (typically two regular cleanings per year and a discount towards dental procedures)

Does your plan have any wait periods?

Some dental plans will require you to wait a period of time before they will pay anything towards your dental treatment. This means that necessary dental treatment is put off until the plan determines that you are eligible to receive benefits. Many are left with no choice, but to forgo their wait period and receive no benefit from their insurance.

Are there any special clauses or downgraded benefits?

Most plans will have clauses which your employer negotiated with the insurance company in order to get a better rate on the plan. Many plans have loopholes to benefit the insurance company and not the patient. For example, they will often downgrade crowns and fillings to a metal filling, while most dentists only offer tooth colored materials. Most also exclude coverage towards nitrous, fluoride, preventative sealants among cosmetic services. This lack of transparency can be frustrating for plan participants. It is important to ask your company’s HR department about any special clauses or exclusions so that you aren’t left with surprise dental bills.

Do they give you the freedom to choose your dentist?

Many plans will limit you to a select list of providers. Most of these providers may be “discount” or corporate dental chains that have an agreement with the Insurance company. It is important to ask if you as the participant have the power to choose your own dental provider.

How much is the annual allowance?

Each dental plan will have a maximum annual allowance that they will pay to either cover or reimburse you for your dental services. This total is on average $1000-$2000 per year. This included your preventative visits, which by themselves average $300 per year. Due to low insurance reimbursement rates, most will not receive the full benefit of their annual allowance. One study showed that only 2.8% of dental plan participants actually met their maximum.

We hope that this information helps give our patients the ability to make informed decisions about choosing whether or not your dental plan is right for you. For those that wish to forgo their employer’s dental insurance plan and save their monthly premiums, we offer an annual Dental Wellness Membership. Learn more about our Wylie, TX Dental Wellness Membership here.