Have you had dental insurance for years, but for one reason or another — perhaps because of anxiety or simple inconvenience — haven’t been able to use it until now?
For people making their first trip to the dentist in a while, it’s common to wonder whether they can take advantage of all of the unused benefits from years’ past.
Does your annual dental coverage accumulate? Is it possible to roll benefits forward, “saving” it up for when you really need to use it?
For most treatments, no…but there are a couple of exceptions.
Most Dental Plans Won’t Let You Save Up Unused Benefits
Maximum annual allowable amounts are the dollar totals that your insurance pays for each year.
For example’s sake, we can say that your insurance plan covers up to $1,500 in annual allowable amounts. But the “red tape” so to speak, is that those unused funds go away as soon as the end of the year, resetting again on January 1st. If you only use $500 of your annual allowable, you can’t carry the remaining $1,000 into the next calendar year. Come New Year’s Day, you’re back at $1,500 again. This can be convenient if you have a big treatment scheduled for November or December, and another one in January or February.
Since dental insurance is prevention based, the annual allowables are there to help take care of any minor to moderate conditions that pop up during the calendar year, rather than pay for major dental work (like full mouth reconstruction, etc.)
Which Treatments You CAN Get from Unused Benefits (or Not at All)
There are always exceptions it seems when it comes to dental insurance benefits. When it pertains to certain types of dental treatments, there are situations where insurance will only pay for them once in your entire lifetime, never resetting at the end of the year.
Take orthodontic therapy as an example. Perhaps your family’s plan will pay up to $1,500 for orthodontic treatment (braces) in your lifetime, or after a certain age. If your child requires two phases of therapy, they may only be able to have benefits applied to the first phase but not the second phase a few years later.
Certain types of dental X-rays are restricted by scheduling as well. Full mouth diagnostic series (like an “FMX”) or panoramic film is usually only covered once every 3-5 years. Having one taken too soon will typically be rejected by your insurance carrier.
Bottom line, once the year passes, your unused dental benefits do too.
You Can’t Roll This Year’s Benefits to Next Year, Either
Maybe you’ve just joined a new dental insurance plan and it’s already halfway through the year. You know you won’t be using up all of your benefits by the holidays. Will they still re-set on January 1st? Yes. In fact, if you don’t time your new coverage just right you might find that you actually pay more for your insurance coverage than what you need your insurance to pay for on your dental visits.
That’s right; if you don’t time your appointments right or use the benefits that you’re entitled to, your dental insurance may actually wind up costing you more than what you’re getting back out of it.
Make Sure You Ask About Waiting Periods
Perhaps you’re ready to immediately start taking advantage of your insurance coverage before the end of the year. You figure that with at least 3-4 months left on the calendar that it’s more than enough time to get caught up on all of your dental work.
But after your checkup, you walk away finding out that the crown you knew that you needed is going to have to get put off because of something called a “waiting period.”
What is a waiting period, you ask? It’s a set amount of time that your insurance carrier makes you wait before getting a large payout on your dental treatment. Essentially, it gives your carrier several months of you paying into the plan before they will pay for certain types of more expensive treatments.
Spacing Out Your Treatment to “Save” Money
Eventually you may come to the conclusion that it’s best to spread out the different treatments you need over the next several months or even years. Have a few fillings this year, extractions next year, and implants the year after; that way your insurance benefits get used up each year and you’re capitalizing on every dollar of coverage you’re entitled to.
Although this idea might sound good in theory, it can wind up costing you more in the long run. Diseased gums and decaying enamel can become worse and more expensive to treat, affecting other teeth at the same time.
Is Paying for Dental Insurance Worth It?
If you know that you need to have extensive dental work and will use up the coverage included in any plan that you sign up for, you may want to opt for a more money-savvy option like a dental savings plan. The programs through Aetna Dental Offers can save members 15-50% on treatments with no annual maximums!