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How Do My Dental Insurance Maximums Work?

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In a perfect world, all medical and dental treatment would be free for all Canadians. We would be able to get the treatment we need, we could stay healthy at no cost, and not have to worry about our bank accounts. Unfortunately we’re not quite there yet…

Luckily, there are ways to get treatment and save money – that’s why we have insurance! Since the mid-1950s, dental insurance has been a crucial means of saving people money when they need dental treatment. You pay a set cost for the premium every month, and you’re covered for most basic dental services.

Having a plan can greatly reduce your dental bills, keep your dental health in great shape, and give you the peace of mind that you won’t go broke taking care of yourself or your family.

How Do Maximums Work?

Every dental plan has a maximum amount that they will pay every year. Some plans may run on a consecutive month basis, while others pay by calendar year, from January to December. For example, your plan may pay $1000 between January 1, 2018 up to December 31, 2018. Once 2019 rolls around, the maximum will be replenished.

If you have a dental visit that includes a cleaning, polishing, x-rays, and an exam, the total cost will be applied to your maximum. Later on in the year, if you need to have a filling placed, the cost will also be deducted from your account. If your costs exceed the yearly amount, you will need to pay the remainder out of pocket.

Can I Give My Amount to Another Family Member?

Let’s imagine that you have a dental plan and your spouse needs a lot of dental treatment this year. They have many cavities to fill and a cleaning as well. The total cost of the treatment will be several hundred dollars more than what your plan will pay per person. You have only had a checkup, and have more than enough available in your account. Can you switch?

Unfortunately, dental maximums are only applicable per person. If your spouse’s dental bill exceeds the maximum amount, the remaining cost would be your or your spouse’s responsibility.

Optimizing Your Maximum

There are ways to avoid going over your yearly dental maximum. If you schedule your regular cleanings (which are usually every nine months) so that you only go once in a calendar year, you can avoid depleting your funds with nothing but cleanings.

dentist-healthcare-medical-schedule-appointment-concept

If you require further treatment like a root canal, or fillings, you may want to limit them to one or two per year, depending on how much coverage you have available. If you aren’t sure about whether or not you’ll have enough, it’s strongly recommended that you send an estimate to your insurance provider.

Do Maximums Carry Over?

Unlike cell phone minutes, dental maximums do not carry over to the next year if they’re not used. Dental insurance providers will allow you a set amount of money, per person, per year. You do not collect that amount and add to it if it doesn’t get used. So if your plan will pay $1000, that amount is for you, and you have a year to use it. If you don’t, that’s fine; it will be $1000 the next year.

Why Estimates are Your Best Friend

Sending a dental estimate to your insurance provider is one of the smartest things you can do. It can be challenging keeping track of how much money you have remaining, but it’s also tough to know which services are covered, whether they are considered basic or major dental, and just how much will be eligible.

Let’s say your dentist says that in addition to fillings, you also need some crowns done. If you send an estimate, not only will you find out if they’re covered, you will also discover that fillings are considered a basic treatment and will be deducted from your basic dental maximum, but also that crowns are considered major, and you have a separate maximum for that.

Major services almost always have their own maximum, but are usually payable at a lesser percentage. For example, fillings may be covered as basic, payable at 80%. Crowns may be covered as major, payable at 50%. This can be very confusing!

All services are covered under one annual maximum, including basic services such as fillings, tooth extractions and x-rays.  Comprehensive basic such as root canals or major services such as crowns, bridges or denture work (when eligible), they will all fall under the annual maximum of the plan.

Usually there is only one annual maximum (with the exception of Orthodontics, which is usually separate and has a lifetime maximum associated with it). Percentages of coverage vary for the different services.  An estimate or pre-treatment plan is REQUIRED by most insurance carriers for any work that will exceed $300.00 this protects both the patient and the insurer and eliminates any surprises.

An estimate can get everything in writing, showing what your maximums are, what percentage things will be paid, and how much money you have available. You can then decide if you will go ahead with the treatment, and you will also know in advance how much you’ll be paying out of pocket.

Estimates are also good because if you find out that the procedure your dentist recommended isn’t covered, the dentist can then switch to another procedure that would be covered.

Don’t Wait, Get in Touch!

Dental maximums are an important thing to look at when shopping for a dental insurance plan. If you’re searching for one, take a look at the maximums offered. Give our office a call today and one of our customer service representatives will be happy to walk you through it and find the perfect plan for you. Something else to consider is the co-payment.  If you have a high dental maximum but a very low co-pay then is it really worth it?

Your health is important, and that includes your dental health. Keep yourself safe both in health and in finances by getting on board with us.

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