A new year brings fresh starts, ambitious resolutions, and, whether you realize it or not, a reset for your dental insurance benefits.
For patients with dental insurance in Michigan, knowing how this reset works can save you money on dental care. It’s like having access to a secret coupon book for your oral health. So, before the year gets away from you (again), let’s break down what happens when your dental insurance renews and how you can make the most of your dental insurance benefits.
Why Does My Dental Insurance Reset?
Your dental insurance is a little like your phone’s data plan. You get a set amount to use during an allotted time period. If there is some leftover at the end, the extra amount doesn’t roll over. It simply disappears.
Most dental insurance plans follow the calendar year. That means your plan runs from January through December. As the ball drops on New Year’s Eve, your dental benefits reset. You enter into the new year with a fresh start, for yourself and for your teeth.
Each year, your annual maximum, deductible, and eligibility for certain treatments will reset.
Let’s break down what those fancy insurance words actually mean, without any of the confusing fine print.
What Is an Annual Maximum?
One of the most important (and misunderstood) parts of dental insurance is something called the annual maximum.
Your annual maximum is the amount your insurance company will pay toward your dental care during the year. Once that limit is reached, any additional treatment costs become out-of-pocket expenses.
Most plans have annual maximums that range between $1,000 and $2,000. To learn your exact annual maximum, you’ll need to contact your dental insurance provider.
What Is a Deductible?
Your deductible is the amount you pay before your insurance begins contributing to certain treatments. Most dental insurance deductibles range from $50–$100 per year for an individual and $150–$300 for a family.
What Does Dental Insurance Usually Cover?
Dental insurance coverage varies by provider. However, most dental insurance companies divide treatment, and coverage ranges, into three categories:
1. Preventive Services
Most dental plans cover these treatments at 100%.
Preventive treatments include:
- Cleanings
- Exams
- X-rays
- Preventive screenings
Usually, preventive care is exempt from the deductible. That means your regular cleanings and exams are covered by insurance even before you meet your deductible.
Insurance companies do this for a reason: preventing problems is a lot cheaper than fixing them later. Regular dental checkups help keep bigger, more expensive problems from developing.
2. Basic Procedures
These dental services are typically covered around 70–80%.
Basic procedures include:
3. Major Procedures
Major services are generally covered around 50%.
For most dental insurance plans, major procedures include:
- Crowns & Bridges
- Dental implants
- Dentures
- Some surgical procedures
Of course, understanding what dental insurance covers is just one piece of the puzzle. If you’ve still got questions, you’re not alone.
Common Dental Insurance Myths
For many patients, dental insurance feels like an unsolved mystery. Unfortunately, there are plenty of myths floating around that make it even harder to know what to believe. Let’s clear up a few of the most common dental benefit myths so you aren’t fooled by the fables.
Myth #1: Dental Insurance Covers Everything
We wish! If that were the case, dentists everywhere would be handing out free teeth whitening trays with every cleaning.
The goal of most dental insurance plans is to make both preventive and restorative care more accessible. It is designed to help offset costs, not eliminate them entirely.
Although preventive care is usually fully covered, the cost for restorative care is often split between you and your insurance provider.
Procedures that the insurance company considers cosmetic dentistry generally aren’t covered at all. Braces are also not generally covered under regular dental insurance plans. Some insurance companies offer orthodontic benefits as an optional add-on, though.
Myth #2: If Insurance Doesn’t Cover It, I Should Wait
Waiting often makes dental issues worse (and more expensive to fix). Addressing issues early can often save both your teeth and your wallet.
If you are struggling to figure out how to pay for necessary dental care, talk to us! We can sometimes divide your treatment up in a way that fits your budget. If that isn’t an option, we will help you get signed up for payment programs like CareCredit, or even our membership club for patients without traditional insurance. Finances shouldn’t keep you from caring for your overall health.
How to Choose the Best Dental Insurance in Grand Rapids, Kentwood, & Surrounding Area
When patients ask “what is the best dental insurance in Michigan?” the honest answer is: it depends.
The best plan for you will depend on:
- Your dental health history
- Whether your dentist is in-network
- Coverage percentages
- Annual maximums
- Waiting periods
A plan that works perfectly for one person may not be ideal for another. If you are comparing dental insurance plans in Grand Rapids, there are a few key things to consider:
- Check the Provider Network – Finding an in-network dentist can help you keep costs low.
- Review Coverage Percentages – Look at how much the plan covers for preventive, basic, and major procedures.
- Understand the Annual Maximum – If you know you are going to need major dental work, choosing dental coverage with higher maximums can help keep your out-of-pocket costs low.
- Watch for Waiting Periods – Some plans require you to be enrolled for several months before they will cover major dental work.
At Polished Dental Care, we know that reading through your dental insurance policy probably isn’t your idea of cozy Sunday afternoon entertainment. That is why we make navigating dental insurance as easy as possible.
How Polished Dental Care Makes Dental Insurance Easy
We strive to make using your dental insurance benefits simple and stress-free. No matter which dental insurance provider or plan you have, our team will submit claims on your behalf.
If you don’t have dental insurance, we won’t turn you away. We believe everyone deserves access to high-quality dental care. Our in-house membership club makes it easy to get the treatment you need at a price you can afford.
4 Tips for Maximizing Your Dental Insurance Benefits
Once you find the right dental plan for you, these four simple strategies will help you get the most out of your insurance benefits:
1. Schedule Preventive Visits Early
Most patients are eligible for two cleanings per year. Scheduling the first cleaning early in the year and the second near the summer gives you plenty of time to fit in any necessary dental procedures before your dental insurance resets.
2. Don’t Wait Until December
Dental offices get busy toward the end of the year. Patients rush to use their remaining benefits before the clock strikes midnight on December 31. Parents scurry in to squeeze their kids’ exams between holiday concerts, shopping trips, and cookie baking.
If you can avoid it, get your dental care done before the holiday lights start to twinkle. It will be easier on your wallet and your schedule.
3. Plan Big Dental Procedures Strategically
If your dental needs are bigger than your insurance maximum, all hope is not lost! Some procedures can be scheduled across two benefit years to help maximize your coverage. If finances are an obstacle, tell us! We can talk through options to make your treatment more accessible.
4. Ask for a Pre-Treatment Estimate
One of the best ways to know what you’ll be expected to pay for a dental procedure is to request a pre-estimate. We can submit the pre-estimate to your insurance provider so that you have a clear idea of what your out-of-pocket cost will be before the dental procedure starts.
Enjoy a Fresh Start for Your Smile
The beginning of the year isn’t just for opening gym memberships and buying pretty new planners. It’s also the perfect time to start taking advantage of your freshly reset dental insurance benefits.
Understanding how your annual maximum, deductible, and coverage percentages work can help you make smarter decisions about your dental care.
If you’re trying to figure out dental insurance in Grand Rapids or Kentwood, our friendly dental team is here to help! No confusing insurance jargon. No surprises. Just healthy teeth and a confident smile.
Give us a call today at (616) 698-6663 to schedule your routine dental care or ask about our membership club.
