7 Tips to Maximize Your Dental Insurance Benefits

Having dental insurance is one way for you to ensure your teeth and gums remain as healthy as possible. But dental insurance can be tough to navigate, so you may not know how to fully take advantage of your dental benefits, which could mean you’re paying more for dental care than you should. Follow the tips below to feel confident you’re maximizing your dental insurance and saving as much as possible on your dental care.

1. Schedule preventive appointments

Even if you think your teeth and gums are healthy, it’s still important to schedule a regular check-up with your dentist. Most dental insurance plans let you schedule two preventive appointments —cleanings and checkups — each year at no or a very minimal cost, so make sure to take advantage of it. These checkups are vital because they allow your dentist to detect early signs of oral health problems such as tooth decay or gum disease before the problem becomes severe and expensive to treat.

2. Understand your dental insurance

Dental insurance policies can be confusing, so take time to know the finer details of your plan. Here are some key terms you should get familiar with:

• DHMO plan — DHMO stands for Dental Health Maintenance Organization. With a DHMO plan, you can only use a primary care dentist or specialist within your insurance’s network. Your insurance provider pre-pays a certain amount each month for each patient that has been assigned to a specific dentist (your primary dentist) who then provides services at a reduced cost. (A few DHMO plans have an open access network, which allows you to choose any in-network provider.) There is typically no annual spending cap for these plans, but there may be service frequency limitations.

• DPPO plan — stands for Dental Preferred Provider Organization. With most DPPO plans, you can choose to see any dentist in-network and may be able to see out-of-network providers. You’ll save the most if you stay in-network. These plans generally cost more than HMO plans but enable you to choose your dentist and don’t require you to have a primary dentist. DPPO plans typically have an annual spending cap of $1000-$1500.

• Deductible — The dollar amount you must pay before claiming benefits under your plan. Typically, the deductible is $50 per plan member. You pay your deductible once every plan year.

• Copayment — A fixed dollar amount you pay when you visit the dentist. This is usually the type of payment system used by DHMO plans.

• Coinsurance — A percentage of the cost of care, this is typically the type of coverage you get with a DPPO plan. You pay the coinsurance cost out-of-pocket, and your dental plan pays the rest, until you reach your annual maximum.

• Annual maximum — Also known as an “Annual Cap,” this is the maximum amount your insurance will pay for dental services within 12 months. DPPO plans typically have an annual maximum, as noted above, while DHMO plans may limit how often you can get specific services/treatments.

• Plan Year — Your plan resets annually, a year from the day you first purchased it. When your DPPO plan resets, your annual spending cap and deductible return to the original amount.

3. Use in-network providers

To minimize out-of-pocket expenses as much as possible, it’s best to choose an in-network provider — a dental professional who your insurance company contracts to provide dental care at a negotiated rate. If you have a DPPO plan, you’ll pay less for dental procedures by visiting a dentist in your insurance network instead of one out of network. With a DHMO plan, you must see your primary dentist for care and referrals to specialists.

4. Know your annual maximum limit

The annual maximum is the maximum dollar amount your dental insurance will pay toward dental care costs within a 12-month period. While the amount varies among insurance plans, you can expect your annual maximum to range between $1,000 to $1,500. Knowing this amount is important because the annual maximum doesn’t roll over to the next year, so you must use it or lose it.

5. Schedule major dental procedures strategically

Some major dental procedures, such as getting dentures, are often done across multiple appointments. If you think a certain procedure might exceed your annual maximum, ask your dental professional if you can schedule part of it before the end of your plan year and the other part at the beginning of your plan year. That way, you’ll be able to use two annual maximums instead of just one, without delaying care.

6. Keep track of claims and benefits

As you receive dental care, track your claims so you know when you may hit your annual maximum. Review your treatment summary after each appointment and see what your insurance covers. Then, subtract that amount from your annual maximum to find out your remaining coverage for the period. For DPPO plans, your annual spending limit is the part your plan pays and does not include your out-of-pocket/coinsurance costs.

7. Consider a dental savings plan

If you need more coverage than your annual maximum provides, consider getting a dental savings plan. It’s an affordable alternative to traditional dental insurance. Plan members report an average savings of 50%* on their dental care.

And, unlike dental insurance, there are no annual limits. You can use your dental savings plan as your primary way to save money at the dentist, as a supplement to your dental insurance to fill coverage gaps, or to reduce the cost of dental care if you exceed your insurance’s annual spending limit (talk to your dentist to coordinate).

How do I join a dental savings plan?

Your first step is finding the plan that helps you save the most on the dental care you need. DentalPlans.com is the largest dental plan marketplace, with more than 25 dental savings plans and dental insurance plans from the most trusted brands in healthcare. You can count on these plans to save you money at over 70% of U.S. dentists.

We make it easy to find the plan that’s right for you. Give us a call at 1-833-735-0399 and we’ll help you find your best plan in minutes. Want a quick peek right now? Use the calculator below to see how much you can save with a dental plan.

*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.