Prime Smile’s Blog

For most patients, dental benefits renew each January, while others renew on an enrollment date or fiscal year. Studies have shown under 3% of PPO dental plan members use all of their allotted benefits each year. This could mean thousands of wasted hard-earned dollars per family.

Most traditional dental benefit plans have yearly maximums and specified coverage limits on procedures (100% coverage on cleanings, 80% on restorative treatment, etc.). Some plans have a deductible on larger treatments too.

Some employers offer a flexible spending account, or FSA, instead of or in addition to dental coverage to help offset deductibles and coverage limits. Each year, the employee specifies an amount of money to be put in the FSA account, which is usually accessible through a debit card. For example, if your dental insurance covers a root canal at 80%, the FSA account could be used to pay for the remaining 20% that would otherwise be an out of pocket expense.

But don’t wait until mid-December to schedule an appointment, because many dentists will be booked solid with patients trying to use up their plan benefits. If you haven’t been in recently, make an appointment or call the office and see if there’s any outstanding treatment in your record that could be done. Are you overdue for a cleaning? Do you have a filling that needs to be replaced? Now is a great time to start getting those appointments on the books.

Whether you have traditional dental coverage or an FSA account, here are some tips to maximize your dental benefits and reasons why you should use them before the new year.

Unused Benefits- Each year your yearly maximum renews and you forfeit any unspent money. Many plans range from $1,000 to $1,500 per year or more. If you have been delaying treatment or only going for cleanings, that’s money flying right out the window.

You’re Throwing Money Away- If you are paying for dental coverage but only going in for cleanings, you’re not recouping much of the money you spend on your annual premium. It makes much more sense to use every last dollar of available dental coverage to offset the cost of the benefits. For example, if your $400 annual premium buys $1,000 worth of coverage and you're not using it, you’re effectively throwing away $600 of “free” money.

Plan Deductibles Reset- Some dental plans have a deductible on more extensive procedures like root canals or crowns. When the plan restarts, so does the deductible. If you’ve already paid the deductible and need another procedure, it might be worth getting it done in the same year and saving a little money.

You Might Be Able to Overlap Needed Treatment- Most dentists don’t recommend postponing treatment, especially if it’s a two-step procedure like a root canal followed by a crown. If you have a tooth that needs a lot of work you may be able to overlap the treatment between this year and next. This reduces your out of pocket cost and repairs your tooth in a timely fashion before there is any further damage.

Schedule Treatment Before Any Fee Increases- Occasionally your dentist raises his or her fees to offset the high overhead of running a dental practice. Dental offices have some of the highest overhead expenses in any industry and most of them happen behind the scenes. Liability insurance, the cost of state-of-the-art equipment to enhance the patient experience, training for that equipment, and single-use items like gloves and sterilization pouches continue to increase. Getting scheduled for any outstanding treatment now could save you a little money down the road.

Maybe you’ve been considering redoing an old crown that’s a shade too dark or want to replace those amalgam (silver) fillings with tooth-colored composite. Or perhaps you’ve been delaying a large treatment plan. Whatever the reason, you work hard for your money. Even if your dental coverage is paid by your employer, it’s still considered part of your salary. You wouldn’t throw part of your paycheck away, so why waste money by leaving needed treatment undone until it becomes a larger (and more expensive) problem? Use your benefits before the end of the year and make your mouth and pocketbook smile!