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Your dentist has just presented your treatment plan – the dental treatment you urgently need will cost a few thousand dollars. Luckily you have dental insurance. But wait, you’ve already hit your annual cap! What does it mean?
This means that you have exceeded the maximum annual coverage provided by your dental insurance. You must pay for your dental care out of pocket until your coverage is reset at the start of the next benefit period.
Understanding the annual maximum limit for dental insurance
Dental insurance policies generally limit coverage to $ 1,000 – $ 1,500 during a twelve month benefit period. So if your plan has an annual maximum (sometimes called an “annual limit”) of $ 1,500, your dental provider pays their share of your dental care until they have paid that $ 1,500. You then pay for your dental care out of pocket until your plan is reset.
A typical dental insurance plan offers what is called “100-80-50” coverage. This means that insurance will pay 100% of the cost of routine preventive and diagnostic care – typically two exams with cleanings per year. Once you reach your deductible (usually $ 50 to $ 100), most dental insurers pay 80% of the cost of basic services such as fillings or root canals, and 50% of the cost of major procedures such as crowns and bridges. You would then pay the rest of the money owed – a process known as “co-payments” or “coinsurance”.
The portion you pay does not apply to your annual limit. For example, if you have a cost of $ 300 to repair a cracked tooth and your insurance pays 80% ($ 240) of the cost, you have $ 1,260 left before you reach your annual limit.
If your oral health is excellent, you cannot maximize your dental insurance. However, that said, a major procedure can easily cause you to exceed your dental insurance limit. For example, the * average cost of a crown today is $ 750 to $ 2,000 per tooth, and the cost of a root canal is $ 750 to $ 1,000 + per tooth (this price can go up soaring if you need complex root canal treatment). While a procedure can maximize your insurance, you will still have to pay your monthly premiums (unless your employer covers the full cost) and you will also have to pay for any other dental care you need until the reset. of your diet. For many people, this can be a significant financial burden.
Save on dental costs by going to the dentist
“For every dollar spent on preventative services like those provided by the Virtual Dental Home demonstration project, an estimated $ 50 is saved on more expensive and complicated procedures,” said Dr. James Stephens, president of the California Dental Association, in an interview with PBS.
Regular dental check-ups also allow you and your dentist to plan ahead for expensive treatments so you can get the most out of your dental insurance and be prepared for any uncovered costs.
Emergency dental care after maximizing insurance
Sometimes, no matter how carefully you plan for the future, a sudden emergency can take a toll on your budget. For example, just biting down on a crisper-than-expected treat can leave you with a cracked, chipped, loose, or even broken tooth, and fixing it can cost more than your annual dental insurance cap. You need it, but you might not know how to afford it. However, delaying it can actually cost you more in the long run and can affect the chances that the tooth can be saved through processes like a dental splint.
A badly damaged tooth can also present a risk of infection. here are the symptoms to watch out for, according to the Mayo Clinic:
- Severe and persistent toothache
- Swelling of the face or cheek
- red gums
- Foul / gustatory discharge
- Difficulty breathing or swallowing
If you experience any of the above symptoms, you should see a dentist or other healthcare professional immediately. If you have no other options, go to the nearest emergency department or emergency room.
Bottom line – you need your tooth fixed. So how can you fit it into your budget?
Affordable dental care options
If you need to fill a coverage gap after you’ve maximized your insurance, there are several ways you can handle the situation without having to delay care:
Ask your dentist about payment plans – they may have a solution that allows you to budget your payments rather than paying all at once.
Think about health care credit cards – these lines of credit are specially designed to help pay for the cost of medical care. Your dentist may have information about this option, so you can ask them for advice.
Consider short-term loan options – your bank, credit union, retirement savings plan, or employer may offer loans or lines of credit for health care or other emergencies.
Take out additional insurance – this type of insurance can help cover the one-off costs of treatments such as orthodontics, but check that there is no waiting period before the coverage is activated and that the specific procedure for which you are need is covered. Again, your dentist can guide you.
Join a dental savings plan – dental savings plans are an affordable alternative to traditional dental insurance that saves you 10-60% on most dental procedures, from braces and prostheses to crowns, root canals and more. There are no annual spending caps, waiting periods, approval processes, or restrictions on pre-existing conditions. These plans are activated immediately so that you can get your treatment immediately. Talk to your dentist to find out which plans he accepts and recommends for your needs.
You can also use DentalPlans.com research tool to compare dental savings plans that are accepted by your current dentist, or choose to sort by the best overall savings in your area, the greatest savings on the specific procedures you need, or the cheapest plan. And you’ll also want to ask your dentist for advice on how best to coordinate the use of your dental insurance and savings plan.
By maximizing your dental insurance, you might feel like you can’t afford the care you need to maintain your health. But with the recommendations above, you can find the option that fits your budget, preferences, and oral health needs, so you can get the care you need and deserve.
Don’t delay dental treatment for financial reasons – poor oral health has been linked to cardiovascular disease, certain types of cancer, respiratory infections, dementia and increases the risk of complications during pregnancy. Untreated gum disease can make it more difficult to manage conditions such as diabetes. Seeing your dentist regularly is one of the best investments you can make in your health and happiness.
* Cost averages obtained from DentalPlans.com procedure finder.
Get 10% discount on any dental savings plan at DentalPlans.com. You can reduce your dental care costs by saving 10 to 60% at the dentist!