What’s the Difference Between Copay and Coinsurance?

by MikeMeehan 3/21/2018 1:39 PM

Copayment and coinsurance are both ways you help share the costs of dental care with Delta Dental. Most of the time, Delta Dental members have a copay or coinsurance, but not both. Here’s what you need to know: Copayment, also known as a copay, is a set amount you are required to pay your dentist for a service. When you have a copayment, you may not have to worry about a deductible or an annual maximum. A deductible is the set dollar amount you have to pay before your dental plan kicks in for covered services. Deductible amounts vary from plan to plan. An annual maximum is the most a dental plan will pay toward your dental care within a specific period, typically a calendar year. Coinsurance is a fixed percentage of a treatment cost you share with your dental plan. For example, you may be responsible for 20 percent of a given service while Delta Dental covers the other 80 percent. Meaning that if your total bill is $100 for a given service, you’ll pay $20 and Delta Dental will pay $80. However, you must first meet your deductible and you may have an annual maximum for the year. To learn more about your dental plan’s copay or coinsurance, login at deltadental.com or on Delta Dental’s free mobile app. You can also call the customer service number on your Delta Dental ID card.

Your Dental Benefits for the Year Ahead

by MikeMeehan 2/21/2018 12:26 PM

Now that 2018 is well underway, your yearly expense planning may also be in progress. As you’re organizing your finances and other paperwork in preparation of tax season, it’s also a great time to check on the status of your dental benefits. Here are some things to consider. First, check to see if your dental benefits renew at the calendar year or the contract year, which is usually based on when your plan actually took effect. For example, if your benefits started in April, your benefits would typically renew 12 months later, in April. If your benefits renew at the calendar year, the annual slate will typically be wiped clean on your benefits such as: Deductible: Your deductible is the set dollar amount you must pay out-of-pocket before your dental plan begins to pay for covered services, so you’ll need to meet this amount again for 2018. Preventive services, such as exams and cleanings, are typically covered regardless of whether your deductible has been met. Annual maximum: This is the maximum amount your dental plan will pay toward your dental care within a specific period, often a calendar year. Your annual maximum reset if your plan renewed January 1. If you were holding off on treatment because you reached your 2017 annual maximum, you may want to schedule an appointment now. While you’re assessing your dental benefits, you may also want to review where you stand on lifetime maximums. This is the maximum amount of money your plan will pay toward specific services, such as orthodontics and prosthodontics, over the course of a lifetime. Many services have no lifetime maximum. Always check the specifics of your dental plan to understand any applicable maximums or deductibles.  

Focus on Preventive Care: The main difference between dental and medical coverage

by MikeMeehan 10/18/2017 4:39 PM

Cavities are almost 100% preventable. Let’s say that again – cavities are preventable. That means it’s within your power to avoid tooth decay. This is a great thing to remember when you’re considering skipping your dentist visit or going to bed without two minutes of brushing. It’s also one of the reasons dental benefits and medical benefits are designed differently. Preventive care is the focus One of the main differences between dental and medical coverage is the focus on preventive care. While you know healthy choices can decrease your chances of getting sick, medical insurance is used when you do get sick or have an injury. With dental benefits, preventive care is the focus. If you visit the dentist for exams, cleanings and X-rays, you can stop oral health problems before they start. Visiting your dental care provider twice a year for cleanings, which is part of your dental coverage, is preventive care. To promote preventive care, many benefit plans with cover all or most of the cost of routine dental cleanings and examinations. Preventive care in addition to your dental benefits includes practicing good oral health habits like brushing twice a day and flossing. Add all this together with smart food and lifestyle choices, and you’ve got yourself a healthy smile. To sum this up, we use medical benefits when we have a health issue, and we use our dental benefits to prevent dental issues. You can live a healthy life with exercise and a good diet, but you can still get sick. You can visit your dentist, brush your teeth and make good oral health choices and you can prevent oral health problems. Emergencies Another difference when comparing dental benefits and medical benefits is emergencies. Dental care emergencies are rare. Getting a tooth knocked out can require emergency care, but dental emergencies do not happen often especially compared to medical emergencies. Medical benefits reflect this difference in care, such as ER and urgent care facility coverage. Stop problems before they begin Dental benefits work to stop problems before they begin. If you work hard with your preventive care, like visiting the dentist routinely, that can help avoid bigger and more costly problems in the future, like cavities or gum disease. Despite the differences between medical and dental benefits, we believe oral health is a big part of your overall health. Study your dental plan to learn more about your coverage, and remember the power of prevention.

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