Dental insurance can seem like a fickle thing if you don’t know much about it. You may be worried about using it during your appointments and ending up with a big bill, but learning more about it can help you use your full benefits. Your Cigna and Aetna dentist is here to help you understand it a bit more! Here are four things that you should know to feel confident about it all.
Deductible
Many dental plans have an annual deductible that you will have to meet. In short, this is the amount you’ll pay out of pocket before your policy provides coverage for certain treatments. However, preventive care isn’t usually included in it. So, you may be able to get your checkups and cleanings without worrying about getting an invoice for the entire service.
Reimbursement Level
Your reimbursement level determines how much your provider is willing to pay for certain treatments after you reach your deductible. The exact coverage for you may be different, but many plans follow a 100-80-50 payment structure.
If your plan is like this, then it means they will cover 100% of preventive care, 80% of basic services (like dental fillings), and 50% of major ones (such as crowns). The best way to know what’s true for you is by talking to your insurance directly or partnering with your dentist’s front desk team.
Yearly Maximum
As you start using your benefits, the total that your insurance will pay toward your dental care is your yearly maximum. So, once you reach it, then you’ll have to start paying out-of-pocket once again. While this typically resets on January 1st, your deductible does as well. You’ll need to reach the latter again, but the former will be zeroed out, meaning you can get coverage once again.
Coinsurance & Co-Payments
Usually, an insurance plan won’t have both of these, but rather one or the other. Here’s what you need to know about them:
- Coinsurance is a percentage that tells you how much you’re responsible for in a certain service. For instance, if you have a 20% coinsurance for a particular procedure, then your policy provider will pay 80% of the bill, and you have to cover the rest.
- Co-payments are flat fees that you pay for a specific treatment. It can be collected before or after your appointment, but it generally doesn’t count toward your deductible.
Remember these four things about your dental insurance, so that you feel confident using it to get the affordable care you deserve.
About the Author
Dr. Ira Newman earned his dental degree from the Emory University School of Dentistry. He is dedicated to helping the New York community with their smiles, offering a wide range of preventive, cosmetic, and restorative treatments, to name a few. Dr. Newman is proud to be in-network with some dental insurances like Cigna and Aetna, so you can get the most out of your benefits. If you want to see how you can use it for your treatments, schedule an appointment or call his office at (212) 924-6890.