Pinnacle Dentistry

Categories: Dentist Tips

Your Year-End Guide to ‘Use It or Lose It’ Dental Insurance Benefits

Published by
bob@tenpeaksmedia.com

According to a February 2024 news post by the National Association of Dental Plans (NADP), at the end of 2022, 293 million Americans had dental coverage. Many received it through employer-provided group plans, others through private or individual insurance, and some via publicly funded programs.

If you or your loved ones in Colorado Springs, CO, also have coverage, it’s essential to know that your plan provides “use it or lose it dental benefits.” It would be a shame to let these go to waste, so it’s wise to use them before they do.

Our caring team at Pinnacle Dentistry put together this guide to help you maximize dental insurance plans. Read on for an overview of end-of-year dental benefits expiration and how using them can benefit you and your loved ones.

What Do “Use It or Lose It Dental Benefits” Mean?

Most dental insurance providers operate on a calendar year basis. Their benefits typically expire by December 31st of each year. If you don’t “use” these benefits on or before this date, you’ll “lose” them because they’ll become invalid and won’t carry over into the new year.

Also, please remember that most dental plans have maximum per-year coverage amounts. If you don’t take advantage of this, you’ll lose the “money” you could’ve otherwise used to cover treatments.

What Treatments Do Dental Plans Cover?

Although the exact coverage varies, most plans often cover preventive services like dental checkups, including cleanings and X-rays. They also usually cover essential treatments, including fillings and extractions. Some even help pay for major dental work, from root canals to crowns.

Let’s explore these treatments and why you should take advantage of their coverage before they expire.

Annual Dental Checkup

Dental checkups can help prevent problems like gum disease and tooth decay from occurring or worsening. It’s often a five-step process for a first-time visit to a new Colorado Springs family dentist:

  1. Initial discussion
  2. Examination
  3. Cleaning
  4. Taking dental x-rays
  5. Oral health and treatment plan discussion

Most dental plans cover 100% of the cost of checkups, but it’s always best to review your plan to be sure.

1. Initial Consultation and Discussion

You’ll discuss your dental and family medical history with your dentist. You should also let them know if you have any specific concerns.

2. Thorough Examination

The dentist will thoroughly examine your teeth, gums, tongue, and throat. They’ll check for signs of oral health woes, such as:

  • Dental cavities
  • Plaque and tartar
  • Bruxism (teeth grinding)
  • Gum disease
  • Wounds, ulcers, bumps, and symptoms of infections

3. Thorough Cleaning

The dentist will clean your teeth and remove plaque and tartar. Removing these is crucial to teeth and gum health, as they’re leading causes of dental cavities, gum disease, and tooth loss. The U.S. CDC even says these are the three oral conditions most affecting Americans’ health and quality of life.

4. Taking Dental X-Rays

Your dentist will also likely take dental X-rays during your first visit. They’ll use the images of the inside of your teeth, gums, and bones to look for problems that aren’t detectable with visual exams alone.

Some examples of what X-rays can reveal are:

  • Number, size, and position of the teeth
  • Cavities between teeth or those hidden by failed or old tooth fillings and crowns
  • Bone loss caused by gum disease
  • Tooth infections
  • Jaw fractures
  • Tooth and jaw alignment problems

5. Oral Health Education and Treatment Plan Discussion

Finally, your dentist will discuss their findings and recommendations. If your teeth, gums, and oral bones are in top shape, they’ll advise you to continue your optimal at-home oral health habits and to say hello to them again the following year.

If your dentist discovers problems, they’ll create a treatment plan tailored to your needs. Depending on the nature of the issue, they’ll discuss cosmetic or restorative dentistry options.

Your dentist can likely treat minor problems (e.g., early tooth decay) on the same day. But for more complex concerns (e.g., tooth infections), they may ask you to schedule dental appointments as these often require multiple visits.

Tooth Fillings

Most dental plans cover tooth fillings, which help restore decayed teeth and fix minor chips and cracks. Fillings help prevent cavities from progressing and causing tooth loss.

As Investopedia points out, most dental plans often cover up to 80% of the cost of dental fillings, although some may cover more.

Dental Extractions

Dentists often pull teeth out as a last resort (they want you to keep as many of your natural pearly whites as possible). However, an extraction may become necessary if the tooth has severe decay or infection.

Like fillings, Investopedia says most dental plans pay up to 80% of the cost of extractions.

Root Canal Treatment (RCT)

A root canal treatment involves removing infected or inflamed dental pulp inside the teeth. The dentist then carefully cleans, disinfects, fills, and seals the treated teeth.

The primary goals of RCT are to remove the infection, prevent reinfection, and save the natural tooth. Indeed, according to the American Association of Endodontists (AAE), dentists treat and save up to 15 million teeth each year with this procedure.

Depending on your plan, it may cover up to 80% of an RCT.

Dental Crowns

Dental crowns are cap-like structures that cover the entire tooth. Dentists use them to repair severely damaged teeth and restore those that have had RCT.

If you need a tooth crown, check your dental plan, as it may cover up to half the cost.

Periodontal Treatment

Periodontal (gum) disease is an infection caused by plaque and tartar buildup. The accumulation can irritate, inflame, infect, and break down gum and bone tissue, including those that keep the teeth in place.

Unless treated, gum disease can cause teeth to become loose and warrant an extraction. It’s a common problem in the U.S.; according to NIH MedLine Plus Magazine, it affects over four in ten adults older than 30.

Many dental plans cover gum disease treatment and may pay up to 50% of its cost.

Dentures

Dentures are oral prosthetic (artificial) devices that replace missing teeth. Patients with one or more missing teeth can get partial dentures, while those missing all of their teeth can get complete dentures. Traditional dentures are removable, while implant-supported dentures can be removable or non-removable.

Some dental plans cover around 25% to 50% of the cost of dentures, including implant-supported ones.

Dental Insurance Tips to Maximize Coverage

Since dental insurance plans cover some or all of the cost of specific treatments, using their benefits before their “expiration” dates can help you save on your oral healthcare expenses. They can even help reduce or prevent other healthcare costs, as poor oral health can affect the rest of the body. For example, the American Dental Association (ADA) points out that there’s a link between gum disease and chronic conditions like diabetes and heart disease.

To help you maximize your dental insurance benefits, consider the following strategies.

Familiarize Yourself With Insurance Terms

Understanding insurance carriers’ technical terms can help you avoid surprise costs and missed opportunities. Some of the most important ones are:

  • Allowable amount: The highest amount payable for services covered by the plan
  • Allowed charge: Maximum amount a carrier will pay for a dental service
  • Annual maximum: The highest amount a dental plan will cover per year
  • Co-pay: Amount paid for each dental visit
  • Co-insurance: Amount you pay for services after meeting your deductible
  • Deductible: Amount you pay for covered services before your dental plan kicks in
  • Exclusions: Specific dental products or services that an insurance plan won’t cover
  • Premium: Amount you pay to the insurance carrier for the dental plan

While many dental plans cover similar treatments and services, the amount or portion of the cost they cover can vary significantly. For this reason, it’s crucial to learn your plan’s exact benefits and exclusions as early as possible. Doing so can help you map out a financially sound strategy that maximizes your benefits while reducing out-of-pocket expenses.

Prioritize Costlier Treatments

Dental insurance fees can increase yearly, so it makes financial sense to use your existing coverage now before paying more for the same benefits next year.

For the same reason, consider prioritizing costlier treatments like crowns, dentures, or implants, as their prices can increase the following year. If you postpone them and their prices jump, you may reach your annual maximum sooner and pay more out of pocket.

Schedule Dental Appointments Early

Dentists often see an increased demand for dental services toward the end of the year. So, scheduling dental visits early is always best to avoid the end-of-year rush and helps ensure you get the services you need before they expire.

Use Your Dental Benefits Before They Expire

Remember, “use it or lose it dental benefits” means they expire, usually on December 31st. Once they expire, you can no longer use or carry them over to your next year’s plan.

Don’t let your dental benefits go to waste! Instead, use them to improve or maintain your oral health with the help of our compassionate, personable, and approachable team and dentists at Pinnacle Dentistry in Colorado Springs, CO.

Our doctors are highly experienced and trusted dentists. Dr. Jennings has served the community with comprehensive, state-of-the-art treatment for 35 years, while Dr. Perett has also helped patients for two decades.

Call us today to learn more about our services and schedule your appointment!

bob@tenpeaksmedia.com

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Published by
bob@tenpeaksmedia.com

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