Make the Most of Your Benefits Before They Expire!
Many patients find dental insurance confusing, and that’s completely understandable. Between deductibles, maximums, co-insurance, and frequency limits, it can be hard to know exactly what your plan covers. At Gregorin Dental we want you to feel confident about your benefits so you can get the care you need and avoid losing valuable coverage at the end of the year.
Here’s a simple breakdown of how dental insurance works and what you should know before your benefits reset.
Your Dental Benefits Run on a Calendar Year
Most dental insurance plans are based on a calendar year, meaning your benefits renew on January 1st and end on December 31st.
Important: Any unused benefits do not roll over into the next year. If you haven’t used them, you lose them! That’s why we always encourage patients to schedule recommended treatments before year’s end; it’s the best way to make the most of your plan.
What Is a Dental Deductible?
Your deductible is the amount you pay out-of-pocket before your insurance begins to share costs. For example, if your plan has a $50 deductible, you’ll need to pay that first portion of your dental expenses before your coverage starts applying to future visits (usually for basic or major services).
Preventive services like cleanings and exams often don’t require you to meet your deductible fees, they’re typically covered right away!
What Is an Annual Maximum?
Each dental plan has a yearly maximum, which is the most your insurance will pay for your dental care within that calendar year. For instance, if your maximum is $1,500, once insurance has paid that amount, any additional treatment costs become your responsibility until your benefits renew.
This is why planning ahead is so important; if you need multiple treatments, we can help schedule them strategically to maximize your benefits over two benefit years.
Understanding Co-Insurance
After you’ve met your deductible, your insurance covers a percentage of the treatment cost, and you pay the rest.
For example:
- Insurance covers 80%, you pay 20% (this is your co-insurance).
The percentage varies depending on the type of procedure and your plan.
What Do “Preventive,” “Basic,” and “Major” Services Mean?
Dental procedures are typically divided into three categories:
- Preventive Care: Cleanings, exams, and X-rays.
– Usually covered at 100% – no cost to you! - Basic Services: Fillings, simple extractions, and periodontal therapy.
– Often covered at 70-80%, meaning you pay the remaining 20-30%. - Major Services: Crowns, bridges, dentures, and root canals.
– Typically covered at 50%, with higher out-of-pocket costs.
Every plan is different, but preventive care is almost always fully covered, and keeping up with your checkups helps prevent the need for more expensive treatments later.
Frequency Limitations: How Often You Can Use a Benefit
Dental insurance often sets limits on how often you can use certain services.
For example:
- Cleanings: usually twice per year
- Bitewing X-rays: once per year
- Fluoride treatment: once per year (for children)
If you’re unsure about your specific coverage, our team can help you check your plan details before your visit.
In-Network vs. Out-of-Network Providers
Visiting an in-network provider usually means you’ll pay lower out-of-pocket costs because the dentist has agreed to your insurance company’s contracted rates.
However, at Gregorin Dental, we can still process claims for most private insurance plans, even if we’re out of network! You can still receive your benefits; the difference is that your coverage percentage or reimbursement may vary slightly depending on your plan.
Don’t Let Your Benefits Go to Waste!
Your dental benefits are part of your yearly investment in your health. By using them before they expire, you can save money and avoid future dental problems. If you haven’t used your 2025 benefits yet, now’s the perfect time to schedule your cleaning or complete any pending treatment. Our team is happy to help you reviewyour coverage and plan your visits before the end of the year.
Call (907) 333-5522 or schedule online today – and let’s make sure you get the most out of your dental benefits this year!
