Dental benefit plans are not designed to cover all dental costs and needs.
Rather, your coverage is based on how much you and/or your employer pays into the plan. Your dentist is not able to influence coverage levels.
Your dentist’s primary goal is to help you maintain good dental health.
Any prescribed treatment is determined with that goal in mind, and not by your level of coverage. Consequently, you may find that you have a dental need that is not covered by your plan.
One of the most impactful limits to your coverage is the annual maximum.
The maximum dollar amount your plan will pay during the year is decided by you and/or your employer’s contract with the insurance provider. The insurance provider passes on to you any costs over that annual maximum.
Other limitations to be aware of are frequency limitations, waiting periods, deductibles, non-covered services, and procedure downgrading.
It’s important to keep all this in mind when deciding whether or not to pursue prescribed dental treatment. Although it may be tempting to make these decisions based on what the insurance company is willing to pay, remember that your health is the most important thing, not the insurance company’s bottom line.
