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Everything you need to know about The Patient’s Guide to Understanding Dental Benefits to ensure your plan meets you and your smile’s needs

The Patient’s Guide to Understanding Dental Benefits

Getting to know your insurance plan can be a lot like reading a menu that’s in a different language…


But understanding the dental benefits that come with that plan is the best way to make the most out of your coverage.


Aside from becoming familiar with your deductible, co-payments, and annual maximum, there are several benefits to look out for that can help you get your dental care needs taken care of at a reasonable price.


Whatever your dental insurance status may be right now, this guide can help you:


  1. Shop for dental insurance plans and make the best decision for your smile
  2. Evaluate your current dental benefits to ensure they meet your dental care needs
  3. Make the most out of your plan at every dentist visit


To start, let’s cover the basics…


Deductibles, Co-pays, and Annual Maximums

These items are the building blocks that make up your insurance plan.


It’s crucial to make sure the foundation of your policy is rock solid so you can save as much money as possible whenever you visit your San Diego dentist.


To paint a picture of what an ideal dental insurance plan might look like, we’ll be doing a brief overview of these three essential elements.



Your deductible is the amount you have to pay before your coverage takes effect.


For the sake of simplicity, let’s say your dental insurance deductible is $100, and you need a treatment that costs $200.


That means you’ll pay the first $100, and your insurance will take care of a percentage of the rest.


Usually, your plan will assign you an annual deductible, and you’ll work towards reaching it as you get dental treatments throughout the year.


Ideally, the lower the deductible, the better…


But most dental plan deductibles are already fairly low –– usually anywhere from $25-$100. The part that can get pricey is the portion you have to pay after you’ve met your deductible and your insurance has covered their percentage of the remaining cost.


This is called the “patient share” or “patient portion.”


Of course, you still want a low deductible, but a lower patient portion is arguably just as valuable. 


However, plans with lower patient portions typically have higher premiums and vice versa.


If you can spare the cash and you know your smile needs extra attention, the lower patient share might be worth the higher premiums.


It all comes down to your budget and dental care needs. 


You know your smile better than anyone, so take all this into consideration when choosing a dental insurance plan that’s right for you.


If you can, find a policy that doesn’t require a deductible for routine cleanings, exams, and other preventive services. 


Most don’t, but it never hurts to check!



Co-payments or co-pays are kind of like ride-sharing with your insurance provider.


Depending on what plan you have, whenever you go to the dentist, they’ll take care of a percentage of the appointment fees once you’ve met your deductible, and you’ll be responsible for the rest.


For example, if each dentist visit costs $100, your insurance may cover $80 of it, leaving you with a $20 co-pay.


But this patient’s share is rarely fixed. It all depends on the dental care you’re receiving, so your cost will vary from visit to visit. 


The lower the patient portion, the lower your co-pays will be. But again, the high-premium trade-off still applies here.


Annual Maximums

Our last foundational item is the annual maximum, which is fairly self-explanatory.


Your annual maximum is the most your dental insurance policy will pay in a year.


So, if your annual maximum is $1,500, your dental insurance will pay a percentage of your care (after you’ve met your deductible) up to $1,500 a year. 


After that, any extra expenses have to come out of your pocket.


This is another situation where you have to consider your dental care needs. 


If you anticipate making frequent trips to your San Diego dentist for the foreseeable future, you may want to look for a high annual maximum. 


And if you’re already locked into your current plan and need some more wiggle room, feel free to ask your employer about how to raise your maximum.


Combining these three crucial components in a way that works best for your smile and budget is the key to maintaining a healthy and happy mouth.


Now, for the moment we’ve all been waiting for…


The Patient’s Guide to Understanding Dental Benefits 101: Everything You Need to Know

If you’re unsure of your benefits or need guidance on what to look for when shopping for a plan, going it alone can be intimidating.


But don’t worry. 


In this section, we’ll be going over some recommendations from the American Dental Association (ADA) as well as our very own team of treatment planners.


By the end, you’ll have a strong grasp of what benefits work for you as a patient and how well your current plan addresses your dental care needs.


Here’s a list of questions to ask yourself when looking over (or looking for) your dental insurance plan:


Can I Pick My Dentist?

Finding a good dentist is hard enough. 


If you’re happy with your current dental provider and your insurance plan requires you to find a new one, it may be time to look for other options.


The ADA backs up this statement, recommending that patients go with a plan that allows them to choose their ideal dentist.


Can I See a Specialist?

With a family dentist like Dental Express, specialist referrals are few and far between.


But depending on your dental health, they can be necessary from time to time. 


If your insurance plan doesn’t allow for specialist referrals, then you may have to explore other payment methods like Medi-Cal Dental (if you’re a California resident), low-interest medical financing, or simply paying out of pocket.


In your quest to find the ideal dental policy, make a point to look for one that offers coverage for specialist care.


Does My Plan Have a Waiting Period?

Some dental insurance plans have waiting periods, requiring you to wait a certain amount of time before your benefits kick in.


As crazy as it sounds, depending on what plan you end up with, you could be waiting anywhere from a few months to a full year!


This can be a huge problem if you have urgent health needs or a pre-existing condition. 


If you know you’ll be seeing the dentist often, look for plans that don’t include waiting periods. 


According to the ADA:


“Even though your plan may have a waiting period, you may still need immediate treatment to keep your mouth healthy.”


If you’re in the middle of a waiting period and need care, contact your insurance provider to see if there’s a way to shorten it, or get in touch with your local San Diego dentist for affordable financing or other options.


Maximize Your Benefits (and Savings) at Dental Express

Dentistry is a team effort between you and your provider that requires trust and integrity…


And unfortunately, finding a provider that has your best interests at heart isn’t easy.


That’s why at Dental Express, every decision we make starts with YOU.


We’ve made it our mission to remove as much financial stress from dentistry as possible. 


If you need a series of treatments, but your budget can only accommodate so many a year, then we’ll space them out to fit comfortably into your lifestyle.


We pride ourselves on putting patients first, and it’s our promise to you and the people of San Diego to continue doing so.


Whatever your dental coverage looks like, we’ll work with you to maximize your benefits, savings, and dental health.


If you have any questions about your insurance or you’d like to get started, you can schedule an appointment online or give us a call at any of our locations. 


We’d love to help you apply your benefits at Dental Express!


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