Don’t Let Your Dental Insurance Benefits Go To Waste

By Jeremy Archibald Family and Cosmetic Dentistry | September 1, 2019

With a chill in the air and pumpkin spiced lattes on the lips, you know that the fall season has firmly arrived. Along with the changing colors of the fall foliage and the all-too-soon holiday music on the radio, the season also marks the beginning of the end of your dental insurance benefits. With just a few more months left before the calendar flips to 2020, it’s important that you don’t let your remaining benefits expire.

Maximizing your yearly dental benefits before December 31^st can go a long way towards keeping your smile looking and feeling its best throughout the rest of the year. So you know what’s at stake and the best methods for maximizing your yearly benefits, let’s take a look at how you can get the most out of your dental insurance.

Working Within the Cap

The majority of dental plans work using a cap that limits the amount of benefits any one person can receive in a calendar year. Once you go over the cap set by your dental insurance provider, you’ll be required to pay out of pocket any remaining expenses.

For example, say your insurance plan provides $2,000 a year in dental benefits. Unfortunately, your oral health requires a procedure like the placement of a dental implant and crown that costs $2,500 to complete. Subtracting what your plan will pay for versus what you owe means you’ll need to pay at least $500 out of pocket to cover the cost of your care.

Unlike vacation time and credit card interest, dental benefits don’t continue to accrue over time. Once a benefit year comes to an end – this typically occurs on the last day of the year – any unspent benefits simply expire. This makes it important that patients keep track of how much of their benefits they have remaining so that nothing goes to waste.

Maximizing Your Benefits

Even though yearly dental benefits typically have a hard cap when it comes how much a provider will spend on any one patient, there are ways you can have insurance pay for more expensive procedures.

In the example we provide above, the cost of having an implant and crown placed was $500 more than what the insurance plan would cover. However, by scheduling more expensive procedures towards the end of the year, your insurance can cover the cost.

It takes several months for the placement of an implant, as the body needs to heal during the process. If you started the implant placement process in November, the treatment wouldn’t be complete until January at the earliest. By having your care continue into 2020, you get to double dip with your benefits.

The first part of your treatment, the care you receive in 2019, can be paid for with your remaining dental benefits. The remainder of your treatment, the care you receive in 2020, is then covered by your new set of benefits that start on New Year’s Day.

Using the example above: The cost of your care is $2,500 but your insurance will only cover $2,000. By starting treatment before the end of the benefit year, your insurance will cover $2,000 in 2019, and then the rest of the care can be paid for using your 2020 benefits, leaving you with $1,500 worth of benefits for the remainder of the year.

While splitting the cost of your care won’t always be as clean and simple as the example we provided above, you get the idea of what’s possible when you spread out the care you require over two benefit years.

Working Within the Cap

Maximizing Your Benefits

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