July 17, 2016
Insurance has always been detailed and confusing. Deductibles, benefit periods, and similar terms can make your head spin. Now there are all kinds of new terms such as copays, in-network provider, and “major” care. Navigating all of this can be frustrating, but it needs to be done.
Here are some key terms that can help you understand your insurance plan. But keep this in mind: As your dentist in Boone, NC, we work with many kinds of dental insurance plans, but we do not know the details of your specific plan. Dental insurance isn’t as complicated as medical insurance, but there are still many things that can be different from one insurance plan to the next.
- Benefit period (or contract term): Most plans are effective for a year, then restart when the new year begins. However, a “year” is not always a calendar year. This 12-month time span (a normal year or not) is your benefit period. For example, if your dental insurance started on May 1st, your benefit period could run from May 1st through April 30th. This is important because your insurance likely limits your benefits each period.
- Deductible: How much you have to pay each benefit period before insurance starts paying for things. If your deductible is $200, then expect to pay $200 before most of the benefits kick in. However, some dental insurance plans use a copay (see below), which means you pay one price for a regular visit no matter how much of your deductible is left. Some plans will also cover preventive care regardless of your deductible.
- Coinsurance: The amount not paid by the insurance company. In other words, it’s how much you’ll have to pay even with insurance. If a plan will pay 60% of a treatment costing $1,000, your coinsurance would be 40%, or $400. Many insurance plans list what types of treatments are paid by percentage, such as saying preventive care is covered 100%.
- Preventive care: Dental treatments designed to prevent big problems, such as cleanings and exams. Many dental insurance plans pay 100% for this, as it saves them money in the long run.
- Basic (or routine) care: Dental treatments that are common, such as getting a composite fillings for cavities, or root scaling and planing for gum disease. Some plans pay 100% for these, while others pay 80% or less. And what one plan counts as basic, another could count as major.
- Major care: Unusual or big dental treatments, such as dental crowns or tooth extractions. These are rarely covered 100% by your insurance. Again, different plans can label different treatments as major or basic.
- In-Network vs. Out-Of-Network: Many plans negotiate a lower charge from dentists in return for getting more insurance holders (that’s you) to those dentists. This is usually called a network. If you go to a dentist who belongs to your plan’s network, the insurance usually pays more and the dentist usually charges less. You can still visit an out-of-network dentist, but the charges and your portion will likely be higher.
- Copay: A charge you have to pay whenever you visit the dentist. If you have a $40 copay and your dentist normally charges $150 for a visit, you pay $40 and the insurance covers the rest.
- Maximum Benefits: The most your insurance company will pay each benefit period (or sometimes for your whole life). If your maximum benefits for a given year (or period) is $2,000, then once the insurance pays out $2,000, anything above that is all your responsibility. Note that this amount is based on what the insurance pays, not what the total charge is. If your plan pays 50% for a $400 treatment, the insurance pays only $200. Many plans also limit the types of treatments they’ll pay for, such as saying they’ll only pay for so many cleanings and exams each period.
CareCredit For Dental Financing
If your insurance won’t cover a given treatment, or if you don’t have any dental insurance, we can still help you. We have partnered with CareCredit, a financing company that offers lines of credit specifically for covering dental treatments. Depending on your credit and the type of treatment being covered, these lines of credit can be low-interest or even interest-free. To see what you are eligible for, please visit their website at www.carecredit.com.
If you have any questions about your dental insurance, or if you are ready to make your next appointment, call us today at 828-355-5673. In fact, because there are so many different dental insurance plans out there, we highly recommend calling us before you come in.