How Can I Get The Most Out Of My Dental Insurance?

1. See An In-Network Dentist

The vast majority of dental plans are PPOs (preferred provider organizations), which means that you will pay less if you see an in-network dentist. You can still go to an out-of-network dentist, but you may not get the full amount of coverage to which you would be entitled with an in-network dentist. 

At Cibolo Family Smiles, we work with more than a dozen insurance providers including Aetna MetLife, Humana, and Blue Cross Blue Shield, to name just a few, so we’re in-network with most major insurers in Cibolo. 

2. Know The “100/80/50” Rule

Most insurance plans cover your care at a rate of 100/80/50. This means that:

• 100% of preventive care is covered, such as teeth cleanings and oral exams
• 80% of “basic” care is covered, such as fillings and root canals
• 50% of “major” care is covered, such as crowns and bridges

This is one of the many reasons it’s important to care for your mouth properly with at-home oral care. The more serious your oral health issues are, the more you’ll pay out-of-pocket for treatment. 

3. Get Teeth Cleanings & Oral Exams Twice A Year 

For adults, 100% of the cost of two annual teeth cleanings and oral exams is covered, and a set of annual exams is usually provided at no charge. Your kids may also be able to get preventive care like fluoride treatments or dental sealants at no charge if they’re under 18. 

Make sure to make the most of this coverage. Seeing a dentist twice a year lets you maximize your benefits, and also helps keep your mouth healthy.

4. Know Your Deductible And Annual Maximum

Your yearly deductible is the amount you pay out-of-pocket before your insurance plan starts covering your care. This is usually somewhere between $25 and $250. 

Your annual maximum is a related concept. This is the total amount your policy must pay toward your dental care each year. It’s usually between $1,000 to $2,000. Once you exceed this limit, you will be responsible for all expenses associated with your dental care for the remainder of the calendar year.

5. Consult With Your Insurer & Read Your Policy

All of the previous information is broadly applicable to most dental insurance policies, but your specific policy may differ. If you’re still unsure what’s covered, it’s a good idea to consult with your insurer to get specific policy paperwork and information, and read it closely to see what is (and isn’t) covered. This will help you make the most of your coverage.

Schedule Your Appointment At Cibolo Family Smiles Today! 

We accept all major insurance policies in Cibolo, and even if you’re uninsured, we have options like financing with CareCredit to ensure you can pay for the treatment you need. Give us a call at (210) 797-7740 or contact us online for more information or to schedule your appointment with Dr. Niraj Patel right away.