Dental Insurance and FSA ... Use It or Lose It!

Did you know that dental insurance benefits do not roll over from year to year?

Millions of people in the US leave unused dental benefits on the table each year. The National Association of Dental Plans estimates that only 2.8% of people with PPO plans reach their plan's annual maximum. Additionally, many people now have FSAs (Flexible Spending Accounts) which can help pay for their dental care. These type of plans often "run out" on December 31st as well. Here's how we suggest you make the most of any remaining benefits you might have ...

Traditional Dental Insurance 

Many people with dental benefits get them through their employers, though individual plans are also available through Health Insurance Marketplaces established by the Affordable Care Act. Remember, when you buy a plan you and your employer are paying some premium – upfront dollars – that are wasted if you don’t see your dentist.

When You Need to Use Them By

Many insurance companies have a benefit deadline of December 31, and this means that any of your unused benefits don’t roll over into the New Year for most dental plans. Still, some plans may end at different times of the year, so check your plan document or ask your employer to be sure. 

Tips for Making the Most of Your Plan

The key with this type of coverage is to take advantage of any benefits before they expire for the year.

• Prevention is better than treatment both for your health as well as your pocketbook. Most plans typically pay 100% for preventive visits, so if you’re duet, this is a good time to schedule one.

• Start thinking about using your coverage early. During a dental appointment this fall, talk to Dr. Kivel about what your dental needs are and what treatment you might need before the end of the year. Make any upcoming appointments early so you can take care of them before the holidays.

• Once you've determined what your dental needs are, you can work with our front office coordinator or your insurance company directly to figure out what is covered. You can call your plan using the 800 telephone number on your identification card, or usually go to their website for information.

Flexible Spending Accounts

A Flexible Spending Account (FSA) is an account you can set up for healthcare costs. During open enrollment, you choose how much money to put into this account, and a portion of this amount is deducted from each paycheck pre-tax. FSAs generally cover services or products that help keep your mouth healthy, including cleanings, braces needed for dental health reasons, benefit plan co-pays, dentures and more. This huge benefit of this account is spending money that has not been taxed on your health expenses.

Many FSAs work like debit cards, and you can use that card to pay for various medical and dental expenses, including some products available at your local drugstore. 

When You Need to Use Them By

Generally, you must use the money in an FSA within the plan year by December 31. However, your plan may offer one of two options that give you a little more time to spend what’s in your account:

• Some provide a grace period of up to 2½ extra months to use the money in your FSA.

• Others may allow you to carry over up to $500 per year to use in the following year.

Whether it’s at the end of the year or a grace period, you lose any money you haven’t spent. Check with your employer or FSA administrator to see what your plan allows.

Tips for Making the Most of Your FSA

• Plan carefully so you don’t put more money in your account than you will spend within a year on dental or other health care costs.

• As with dental benefit plans, talk with Soulsmile this fall during regular appointments to see if you have any needs or procedures that need to be completed. You may be able to use your FSA to pay for these needs or use your FSA to pay any associated co-pays or co-insurance.

• Contact your FSA administrator for a list of covered services and products (usually referred to as eligible expenses). However, most FSA accounts cannot be used for cosmetic procedures and services like whitening, veneers or cosmetic braces.

• Make any remaining dental appointments as soon as you know you need them to ensure your FSA dollars can be used in time.

Have any questions regarding your own insurance plan, coverage or treatment needs? Call us at 541-482-4995 and we’ll be happy to help!

Dental Insurance Terms Defined

We know it can be very hard to understand dental benefits. At Soulsmile, we are happy to bill insurance as a courtesy to our patients. Our team encounters dozens of different insurance providers, all with multiple plans and “levels” making it impossible to know the details of each one. We always encourage our patients to get to know their dental plan to have the best estimate of what is covered. The only problem with this is also needing to know what many of the insurance terms they throw around even mean. In this blog, we are going to help you understand some of the terms and ideas behind dental insurance so you can feel confident in understanding your benefits.

Annual Maximum

This is the grand total that your plan will pay for dental services for an individual or a family (if you’re under a family plan). Most “years” reset January 1st, but occasionally we see them reset at the enrollment date, so you’ll want to check on this for your plan.

Basic or Minor Services

This is one of a few common categories of dental services defined by insurance companies (along with Preventative and Major, each explained below). Basic services typically fillings, sealants, extractions, periodontal treatment and sometimes root canals. Usually, the same coinsurance (patient payment portion) percentage applies to all services in a group such as Basic.

Closed Network Plan

If you are enrolled in a closed network plan you must see a preselected dentist in order to receive benefits. If you go to an out-of-network office with this type of plan, you’ll need to pay for 100% of your services. More commonly, you’ll find a breakdown of coverage for both in-network and out-of-network dentists.

Coinsurance

This is your share of the cost of services, typically marked as a fixed percentage, of the contract allowance or “usual and customary” fee (see definition below). For example, a benefit paid at 80% by the plan leaves a 20% coinsurance obligation for the patient. This coinsurance applies after a required deductible is met (if necessary).

Contracted Dentist

A dentist who has a contract with your network. In this case, the dentist agrees to accept the insurance carrier’s fees as payment in full for services to plan members. Sometimes referred to as network dentist or participating dentist.

Deductible

A dollar amount that each patient enrolled in a plan (or family under a family plan) must pay before the insurance company begins paying benefits.

Diagnostic and/or Preventive Services

A category of services that usually includes exams, routine cleanings, X-rays and fluoride treatments. These fees are usually covered at 100% for in-network plans and 80% for out-of-network plans. Often times the difference for a patient to choose a dental office like Soulsmile, that might be out-of-network, for a normal exam and cleaning can be ~$20.

Effective date

The date that benefits begin for an enrolled patient. Please be sure to get this information from your insurance company if it is a new insurance plan. We often see patients’ plans with a wait period (often 6 months or 12 months after starting a new job and insurance plan). Sometimes the wait period only applies to selected categories of services.

Eligibility

Circumstances or conditions that determine who and when a patient is covered by the insurance plan. These may include the length of employment, job status, length of time an enrollee has been covered, dependency, dependents’ age.

Lifetime Maximum

The total dollar amount a plan will pay for care for the life of the enrollee or the plan. This type of limitation usually applies to a specific service such as orthodontic treatment.

Limitations and Exclusions

Dental plans often opt to not cover every dental procedure. Each carrier can provide you with a list of conditions that limit or exclude coverage under your plan. Limits are often related to frequency (for example, no more than two cleanings in a 12 month period).

Major Services

This category of services usually includes crowns, dentures, implants and oral surgery.

Out-of-Pocket Costs

Any amount the patient is responsible for, such as coinsurance, deductibles, costs above the annual maximum or cost for services not covered by the plan.

Pre-Treatment Estimate

Pre-treatment estimates are a written estimate of benefits provided by an insurance company in advance of proposed treatment. These are a very reliable way of finding out for a patient exactly what payment they would be responsible for at the time of service. Sometimes referred to as a predetermination.

Provider

Any licensed dentist who performs dental health services for the patient. This can also include dental specialists.

Usual and Customary Fees

This refers to the dollar amount set by an insurance carrier as a reasonable cost for a service. This term only comes into play when you are seeing a dentist who is out-of-network. This may also be referred to as the “allowed amount”. Let’s say your plan has an allowed amount of $98 for a cleaning, and your dentist’s fee is $111. The plan will pay 80% of $98, not $111. The difference in price will be the patient’s responsibility.

Maximize Your Dental Benefits Before January

The end of the year is quickly approaching and with it, the end of another dental insurance benefit year. You're probably thinking more about stuffing and cranberries than dental benefits, but we'd recommend putting aside a bit of time in between your holiday plans to make sure you are maximizing benefits which will be lost as of January 1st. 

1. Don't Throw Away Money,!

Going into a new year with unused benefits is like tossing hard earned dollars you worked for all year. If you're like a majority of people, your insurance plan expires each calendar year. Unfortunately, your remaining benefits do NOT rollover - they expire! Trust us, your insurance company won't remind you of this. In fact, they bank on millions of Americans overlooking this and benefiting them instead of you. 

2. Find Out About Your Annual Maximum 

Each year, your insurance plan sets an annual maximum of dental work they will pay for. This is called the annual maximum. Each plan is different, but this amount is usually $1000-2500. You'll also want to find out how much you've already used this year (if you're a Soulsmile patient here in Ashland, call us - we can tell you!).

3. Consider Pending Treatment 

You may already have a tooth that's nagging at the back of your mind and you know needs to be fixed. Other times, patients may forget about treatment that is not a huge priority (like preventatively replacing old amalgam fillings that are prone to leaking). Give us a call or come in for an exam if you'd like to find out if you have any pending treatment we can put towards your benefits. 

If you have any questions, please call us at 541-482-4995. You can also call your insurance provider directly for more details regarding your unique plan. Our end-of-the-year schedule fills up quickly, so call us today to use up your benefits before its too late!

Insurance Update

Today's blog post is brought you by a special quest author, our office coordinator, Nikki Kirkland, to keep you updated on our insurance information. Here's Nikki ... 

As a service to our patients, we are happy to submit dental claims and maximize insurance benefits to reduce out-of-pocket expenses.  Our office accepts all major insurance carriers, including most employer-sponsored group plans and many individual plans. Currently, we are a Delta Premier Provider, which means our Delta Dental and MODA subscribers benefit from our in-network agreement and fee schedule. We are also a participating provider with Regence Blue Cross Blue Shield, which includes LifeMap, HMA and RGA dental plans. To better serve our patients and community, several additional carriers are being considered for our participation.

As the end of the year approaches, it is important to keep in mind that most dental plans renew on January 1. Dental insurance is unique in that patients have an annual maximum allowed, and any unused benefits at the end of the year are lost. Now is an ideal time to schedule pending treatment and use those remaining insurance dollars. The same concept applies to flexible spending and healthcare savings accounts.

Many of our patients do not have dental insurance, but will still benefit from fair and competitive fees, treatment plan discounts and monthly payment plan options. Our experienced and knowledgeable staff is here to assist you with any questions you may have.

> Please don’t hesitate to contact our Office Coordinator, Nikki with any financial or insurance related concerns.