Breaking Down the Ins and Outs of Dental Insurance and Maximizing Your benefits

Having dental insurance is an important part of making good oral care affordable. However, there are ways that you can make the most of your benefits. Use these dental insurance tips from our team at Matthews Family Dentistry to get great dental care for less out-of-pocket expense.

Dental Insurance Tips 

1. New Year, New Benefits

If you have dental insurance, your benefits most likely reset on January 1st. This means you have more coverage that you can use for any dental work you weren’t able to get done. If you suspect that your smile requires treatments, now is the perfect time to visit your dentist. It gives you plenty of time to plan out your treatment plan over the course of the year to help you make the most of your benefits.

If you’re self-conscious about your teeth, you’re not alone. In addition to cleanings, cosmetic services can help you make your dream smile a reality. Whether your teeth are too discolored, cracked, gapped, or crooked, your dentist can create a treatment plan for you.

Getting a dental checkup as soon as possible this year gives you plenty of time to set smile goals for the next eleven months. Make 2023 the year you finally achieve the bright, beautiful smile you deserve!

2. Out-of-Network Does Not Mean That You Are Out of Coverage

Don’t limit yourself to choosing only in-network dentists when choosing where to get dental care. In fact, just because an office is out-of-network does not mean that they do not accept insurance. The only differences between in-network and out-of-network coverage are whether the dental office has you pay at the time of treatment yourself or pay the insurer later for uncovered services and whether the office has pre-negotiated rates with the insurance company.

Out-of-network providers are considered fee-for-service dental offices. They accept insurance, but you must first pay for the services you receive. Then, you file with your dental insurance company to claim coverage for your treatment. If your insurance company agrees, you could get some of the cost of your treatment paid back.

Additionally, out-of-network providers have not pre-negotiated rates for services with your insurance company, so coverage may vary. Always check your insurance plan for how it handles out-of-network dental office services.

3. Did You Know that HSA Can Help You to Pay for Invisalign?

Your health savings account (HSA) or flexible spending account (FSA) offers more flexible spending than insurance. You can use the funds to cover most types of medical services, from over-the-counter medicine to acupuncture and more. Even dental services your insurance may not pay for, you can pay for with your HSA. Invisalign is one of the many dental services you can pay for with these funds. Other services include dental veneers, crowns with a limit, dental sealants, dental office visits, out-of-network provider costs, and many other dental services.

If you have an FSA, you need to use the funds before you lose them at the end of the year. Similarly, because FSA funds are connected to your employer through whom you get the account, you should use these funds if you will change jobs in the near future.

Don’t leave money on the table or neglect your dental care at the end of the year. Use these dental insurance tips to make the most of your dental coverage and HSA or FSA.

Use Low-Cost or Free Preventative Care Benefits Throughout the Year

Most dental policies offer low-cost or free preventative care throughout the year. Therefore, you should take advantage of these benefits as much as possible. In fact, with regular exams and dental cleanings, you can prevent decay that may lead to more costly restorations.

Another benefit of using preventative dentistry services from your insurance is that by using these benefits, you may cover the cost of the insurance in the money that you save during the year. So, if you’ve ever wondered if carrying dental insurance was worth it, the answer is yes, as long as you make use of it.

Lastly, preventative care and exams can find minor problems when they are relatively cheap and painless to repair. However, if you avoid getting exams and cleanings and only go to the dentist when you have pain, you may find out that you have a problem that has become severe and requires expensive treatment to correct.

For instance, decay in a tooth may not cause pain at first. Spotted early, you may only need a small cavity filling. However, if left too long to progress, decay can impact the nerves inside the tooth, causing serious pain and requiring either you to have the tooth pulled or need a root canal treatment to fix it, both of which are more expensive out-of-pocket than cavity fillings. Regular preventative care can save you a lot of money. Plus, with many insurance plans, you may pay nothing for it.

Check Your Policy on Covered Providers and Additional Services

As a service for our patients, we will typically do a lot of the legwork for you to find out some of the specifics of your coverage.  However, if you have specific treatment needs or questions, it is always a good idea to check with your insurance provider yourself as well. 

Some dental insurance tips and plans don’t cover cosmetic procedures, while others might cover portions of cosmetic dental care. When in doubt, call the insurance provider for more information.

Another consideration for your plan is the maximum amount of coverage that you have in a calendar year. Once you reach that limit, there is typically no additional coverage. If you have major dental needs that could exceed this, consider scheduling some appointments for care before the year is over so that you have next year’s benefits for any additional or unforeseen needs that may come up.  This scheduling prevents you from going over your maximum and paying out of pocket.

Use Flexible Spending Account Money Before You Lose It at the End of the Year

A flexible spending account (FSA) is an additional benefit that some companies offer with insurance plans. These accounts allow you to spend money on dental or vision services that insurance does not cover. For instance, FSA money may help pay for dental implants or in-office teeth whitening if dental insurance does not pay for these.

The downside to FSA money is that it will expire. This type of benefit that you will lose if you don’t spend it all by the end of the year. Therefore, if you have any money left in your FSA in November or December, schedule a visit for your dentist to get the care that your FSA dollars can pay for.

Talk to the Dentist’s Office About Financing Options

Because not everyone has great dental insurance, many dental offices offer financing options to help patients pay for care. You can find many dental insurance tips and payment plans available at Matthews Family Dentistry.

First, if you have payments of more than $1,000 due, and you pay in cash or check, we will give you a 5% discount on your total. Paying upfront in cash or check helps us avoid credit card fees, so we gladly extend a discount to our patients who choose this option.

For patients who have multiple treatments or need several visits, we can provide a pay-as-you-go plan where you pay a little for each visit. Some patients may qualify for automated credit card payments through our in-office financing.

Lastly, you may consider Care Credit or another third-party payment option to spread out the payments over six or 12 months, interest-free! This option is available for those who owe more than $200.

Use a Membership Program If You Don’t Have Dental Insurance

A membership program is perfect for those who don’t have insurance. It’s like a discount plan for our dental clinic. With our Membership Club at Matthews Family Dentistry, you pay a one-time activation fee and an annual fee. For those payments, you get the following benefits paid for each year:

• 15% of dental treatments
• Dental cleanings
• Dental exams
• X-rays when needed
• An emergency visit each year

With different plans for periodontal cleanings, regular dental use, and children, you will find options for everyone in the family.

A Final Note

Although we encourage you to make the most of any dental benefits that you have, we also like to stress that, just as we don’t base our recommendations on your insurance coverage, we advise you to not let that solely dictate your decision to complete or delay treatment.  We are here to work with you and help you make choices that are in your best interest, for your oral and overall health.  Sometimes this lines up with what your policy covers and sometimes it doesn’t.  

Schedule Your Visit with Us at Matthews Family Dentistry to Make the Most of Your Dental Benefits

The best dental insurance tips start with using the policy to cover preventative care. Make an appointment with us today at Matthews Family Dentistry for your cleaning or exam. Plus, if you need additional care, get it done as soon as possible to prevent it from becoming a worse problem requiring higher-cost surgery or extractions. We also have options to help you pay if you don’t have insurance. Let us know how we can help because we want to see you smile.