Dental Benefits 101

As the end of the year draws to a close, I want to remind everyone to schedule your dental appointments with plenty of time. Most dental insurance plans renew in January and any unused benefits are lost. It seems every year we get frantic calls the last 2 weeks in December from patients wanting to schedule their treatment before their benefits expire, only to learn there are no appointments available. Schedule your treatment NOW to take advantage of those benefits!

The other thing that happens around this time is open enrollment for employer benefits for the coming year. Getting regular dental care is imperative to your oral AND overall health. Let’s look at conventional insurance and an option many dentists are incorporating into their practices to make dental care more accessible to all. 

Traditional dental insurance has not changed much in the last 70 years, and we all know the cost of EVERYTHING has increased significantly. Dental insurance plans typically include monthly premiums and a yearly maximum they pay for covered services. Most, not all, cover preventive services at 100%; restorative and other services are covered at a lower percentage. There are also limitations and exclusions. Insurance companies can downgrade what they will pay for a specific treatment. For example, instead of paying for a porcelain crown, they can downgrade to a less expensive crown and then pay their percentage of that lower fee. The patient is left paying for their percentage plus the difference between the fee for the service provided and the downgraded service the insurance paid for.

With membership plans you pay a yearly fee for preventive care and you receive a percentage discount on all other dental treatment. There are no limitations, exclusions, or annual maximums. In my practice, for example, the membership plan is $35/month for the Optimal Oral Health Plan and you receive a 15% discount on ALL treatment. 

I recently did a side-by-side comparison for one of my patients. If they enrolled in their dental insurance and received their preventive care plus 2 crowns and a filling, their out-of-pocket cost was $3589, And, if they needed anything else, they are out of insurance benefits for the year. They either have to delay treatment or pay out of pocket. Under our plan, their out-of-pocket would have been $3442, and all additional treatment is discounted 15%. You never run out of benefits. 

After everything was taken into consideration, the person with the membership plan had a lower out-of-pocket expense. Most membership plans include adult fluoride and oral cancer screening and panoramic images when needed, at no additional costs. They also include cosmetic treatments, which insurances typically exclude. 

For patients without insurance, these membership plans are a wise investment in your oral health. Patients with employer-based insurance should compare those benefits with plans offered by their dentist. If the membership plan is better, maybe your employer may be willing to fund your membership plan instead of your insurance premiums. Whatever your choices, please be sure to include oral health care in your 2023 budget, and don’t let this year’s benefits expire! 

Get In Touch

St. Pete Oral Health Center

Call Us: (727) 345-1774

Visit Us: 6700 Crosswinds Dr. N.Suite 100C
St. Petersburg, FL 33710

Office Hours

Monday: 8:00 AM – 4:00 PM
Tuesday: 8:00 AM – 4:00 PM
Wednesday: 10:00 AM – 6:00 PM
Thursday: 8:00 AM – 4:00 PM
Friday: Closed
Saturday: Closed
Sunday: Closed
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