Dental Insurance Open Enrollment Tips
We understand that Open Enrollment season is upon us!
You might be looking at seven different dental plans and maybe overwhelmed? We wanted to send some helpful tips on selecting your dental insurance plan.
We are in network with many dental insurances.
Note we are out of network with Carefirst, United Concordia, Metlife Federal, BCBS Fed, Medicaid, and any HMO plans if you are switching insurances.
Please call if you have any questions about insurance and if we are in network. Also, you can use your insurance website and search for us if we are in network.
Tips on Selecting Dental Insurance Plans:
- Professionally applied topical fluoride is efficacious in preventing cavities at least 2/year. Some plans cover only 1/year. We recommend selecting a plan with 2 fluoride treatments/year. If your employer only offers 1/year, you can write to your Human Resources department that the Academy of Pediatric Dentistry recommends children receive at least 2 fluoride/calendar year to prevent cavities.
- Annual Maximum is the dollar amount insurance will pay for all dental treatments. We have seen in our office many patients maxing out their annual maximum if they have a low annual maximum. If your family tends to need extensive dental treatments, having an idea of what an annual max will typically cover is helpful.
- Low annual maximum 1000-1500 will cover preventative appointments cleanings and minimal treatment.
- Medium annual maximum 2000-3000 that will cover cleanings and moderate amounts of treatment.
- High annual maximum 3000-Unlimited (we have seen with some United Healthcare, GEHA FEDVIP plans) this is recommended if you have extensive needs like several fillings of the full mouth, crowns, etc.
- Nitrous Coverage There are some insurances that will cover laughing gas for children and adults. Delta will not typically cover nitrous. GEHA FEDVIP has 50% nitrous coverage. Some Cigna plans will cover 90%. Note with no nitrous coverage, nitrous is 155 per appointment.
- Percentages for Coinsurance. Usually Preventative appointments like cleanings, exams, xrays are covered 100%. We have seen some dental insurances dropping the percentages or applying the deductible here so please check this.
Basic services are fillings, extractions. We have typically seen 80%, but have noticed some patients have only 50% or 60% coverage for basic services. This means you will have a higher out of pocket cost for treatments.
- Alternate benefit, Amalgam Downgrade Please check for this clause in your dental insurance plan. This means that if you need white fillings, then your dental insurance will only cover the silver filling rate which means more out of pocket for the patient.
Some Tax Tips:
Note if dental premiums are pre-tax dollars with your employer. If you have a FSA card it is use it or lose it so make sure to use your benefits by year end. HSA cards can be used to cover dental treatments and require documentation with itemized procedure codes If you need an itemized statement please let us know and we will email you any tax documents you need.
Again, our office is here to help you if you need, and we welcome calls if you need any help with answering questions or giving feedback about our experiences with working with dental insurances.
