How to make sure your employer’s new dental insurance plan works for you and your family
Much like a smart shopper, employers are always looking for a better deal on their insurance plans.
As a result, companies often change up their dental coverage.
In some cases, this may not affect your benefits very much at all, but in others, you may have to find a different dental provider.
If you’re going through this right now or you’re simply curious about how to navigate the situation, then you’re in the right place.
In this article, we’ll be going over what to expect, how to get to know your new plan, and how to make sure it meets you and your family’s dental care needs.
What to Expect
Typically, employers will make the change to a new insurance plan at the end of the year during the annual open enrollment period.
Around this time, they’re required to give you all the information you need about your new plan, including any changes compared to the previous one.
Be sure to set aside some time to look through your new coverage during open enrollment to make sure it works for you.
If it doesn’t, you can explore other options and select a different plan before open enrollment ends. If it’s already over, then your benefits are locked in for the next year, and you can switch to a more favorable one at the end of the year.
Getting to Know Your New Plan
To find out if your employer’s new dental insurance coverage will meet your needs, it’s important first to narrow down what exactly those needs are. To help with this process, you can ask yourself this series of questions straight from the American Dental Association (ADA):
- Can you choose the dentist that you want? Will the plan allow for care by specialists?
- What are the total costs for the plan, which include the premium, co-payments, coinsurance, and deductibles?
- What is the annual maximum the plan will pay?
- Is there an out-of-pocket limit? If so, how much is it?
- What limitations does the plan place on pre-existing conditions?
- Does the plan cover braces? Are there limitations?
- Does the program provide for emergency treatment? Are there arrangements for emergency care away from home?
According to the ADA, your coverage summary should include covered services, reimbursement levels, estimated enrollee cost share (what you pay out of pocket), limitations, and exceptions.
If the new insurance information you get doesn’t answer these questions, don’t be afraid to reach out to your employer to clarify.
Here’s another good thing to keep in mind:
Your dental care provider knows your teeth better than anyone. So, they’re one of the best people to ask about what your dental needs are and will be over the course of the following year.
Have a chat with your San Diego dentist if you’re unsure of what benefits you might need.
Addressing Question #1
The first question in the above list is usually the most important when an employer switches insurance plans.
Many people have good things going with their current dentists.
Developing a relationship with your dental care provider takes time, and if you’ve found one you like, having to switch can be a hassle.
A change in dental coverage often comes with a new network of accepted dental providers, so it’s essential to check whether or not you can stay with your current dentist and still receive benefits.
If not, the new dental insurance coverage information should include a list of providers you can choose from.
But even if you can’t find a dentist you like in-network, many preferred provider organization (PPO) plans allow you to visit providers that are outside of your network. You’ll just need to make sure yours is one of those plans.
Situations like these are why it’s essential to get to know your plan as much as possible.
If you’re in the San Diego area, we wrote a helpful blog on what to look for in a local dentist to save you some trouble in your search.
Your employer’s dental coverage may change, but your need for dental care doesn’t – especially if you have a pre-existing condition.
As you go through your new plan, check to see if it has any waiting periods.
A waiting period is a certain amount of time – predetermined by the dental insurance provider – that you have to wait after your coverage begins before you can use your benefits.
For many people, this won’t be an issue.
But if your employer’s new dental insurance plan has a waiting period, and you or a loved one has a pre-existing condition or needs immediate dental care, you may want to consider using an outside plan.
Deductibles and Co-payments
Unfortunately, going to the dentist isn’t a very popular activity for many people.
So, naturally, plans that include deductibles and co-payments for basic and emergency dental services usually aren’t the best idea.
Having to pay to get routine dental care is just another reason for people to avoid going to the dentist.
When looking over your new plan, be sure to note if you have to meet a deductible or pay a co-payment for general or diagnostic treatments.
The ADA states that the ideal dental insurance plan will cover 100% of any preventive, diagnostic, and emergency services.
Dental coverage that allows you to roll over your remaining benefits to the next year can be a huge help, especially if you have a family’s worth of smiles to take care of.
Verify if your employer’s new dental insurance plan offers rollover benefits, it’s a great perk to have!
Picking a Different Plan
If your employer’s new dental insurance coverage doesn’t do it for you, simply follow the criteria laid out in this article and look for a plan that checks all your boxes.
Everyone’s individual needs are different, and there’s a lot to consider.
When it comes down to it, the best choice is the one that will benefit you and your family’s dental health the most.
Your One-Stop for Family Dental Care in San Diego
Dental Express makes family dental care easy and stress-free by providing affordable, patient-focused service.
Whatever your dental health needs are, we work with you and your budget to build your ideal smile together.
Before each treatment, your dentist will evaluate your dental care needs. From there, one of our treatment planners will review your policy to see how we can fit the treatment into your budget as easily as possible.
Typically, there’s a gap between what our patients need and what their insurance will cover, and that’s where we come in. Your treatment planner – and oftentimes your dentist – will team up with you to discuss best options, find a way to maximize your benefits, and come up with a solution that’s best for your smile and wallet.
We accept most PPO insurance, so if your new employer-based dental plan is a PPO, there’s a good chance we’re in your network. To see if we’re included, you can check out our accepted insurance providers page.
Or, you can give us a call at one of our six locations in the greater San Diego area. Feel free to reach out if you’re curious about your benefits, how to apply them at Dental Express, or if you want to take advantage of our new patient special.
We’d love to see you smile and welcome you to the Dental Express family!