Here’s the second Part to our series answering the most FAQ we get from our patients. We hope this will help you better understand your insurance. Feel free to leave a comment if you have a question about something we didn’t cover in this series. We’d be happy to answer it for you!
What is an annual maximum?
Most dental policies have an annual maximum that puts a limit on how much your insurance will pay each year for dental procedures. The annual maximum can vary widely from policy to policy. We’ve seen them range from $500-$5,000.
Here’s a fictitious example to help illustrate:
John Doe went in to see the dentist because he had a toothache. He learned that he was going to need a root canal and crown. The total cost for his treatment was $2,000. This was the first restorative treatment John received that year so he had to pay his policy deductible of $25. After he paid his deductible the insurance company will paid $500. The balance of the bill is John’s responsibility
Insurance portion: $475
John’s portion: $25 deductable + $1500 remaining balance after insurance.
The annual maximum is an important aspect to consider when you’re choosing dental insurance. While a plan which has a $500 annual maximum is likely to have low premiums you aren’t going to get much help from your insurance if you need dental work. The bulk of the cost will end up being out of pocket for you.
When does my insurance policy renew annually and why does it matter?
The month your insurance policy renews, or starts a new year is the month your annual maximum resets to zero and your insurance will begin paying again towards the cost of restorative care. For many insurances this is in January, but there are some that renew in months other than January so it is worth a quick call to your insurance to see when it renews.
When your insurance renews and whether or not you have met your annual maximum can be important to you as you consider when to schedule needed treatment. If you’ve already met your annual maximum it might be possible to postpone your treatment until your policy renews. Once your policy renews your insurance will begin paying a portion (see the first FAQ about percentages of coverage) towards your procedures until you reach your annual maximum again. On the other hand, if you haven’t met your annual maximum your may choose to squeeze in one or two more procedures before your insurance renews. Your insurance will not carry the remainder from one year into the next year. It’s a use it or lose it.
Example: If your annual maximum is $2000 and you have only used $1200 your insurance will still pay their percentage on restorative procedures until they have paid $800 more and you’ve reached your annual maximum of $2000. If you don’t need $800 more in dental work before your insurance renews that $800 is lost and will not carry over to the next year creating a new annual maximum of $2800.
What is a composite downgrade for dental insurance?
A composite downgrade means that your insurance company will only pay the cost of an amalgam (silver) filling. If you want to have a composite (white/tooth colored) filing you will be responsible to pay the difference out of pocket. The difference in cost is usually affordable and well worth it in our opinion. In fact, we only do composite fillings in our office because in our opinion they are a superior filling and we feel that all our patients deserve world-class dentistry using the latest technology, products, and techniques!
Again, if there was something we didn’t cover in this FAQ series please leave a comment and we’ll try to answer it for you!
