Insurance Benefits :: Use It or Lose It
We’re approaching that time of the year again- “use it or lose it!” Each year, many clients lose out on hundreds of dollars through their dental insurance provider, simply because time has slipped away. We know life gets busy and before you know it, another year has come and gone and you have not seen your dentist. Don’t forget to take advantage of your remaining dental insurance benefits before the end of the year! Contact our office today to schedule an appointment at Bluebonnet Dental Care.
Understanding Dental Benefit Categories
Many dental plans offer 3 classes or categories of coverage. If orthodontics is covered, that is considered a fourth class and typically has a separate lifetime maximum payable amount. Each class provides specific types of treatment and typically covers those treatments at a certain percentage. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully.
Here are the typical levels in benefit plans:
Class I (usually called Diagnostic & Preventive)
Procedures are diagnostic and preventive and are typically covered at the highest percentage (for example, 90 – 100% of the allowable dental charge).
Give patients a financial incentive to seek preventive care, because such care can prevent more extensive dental disease.
- Includes procedures such as dental exams, cleanings, and X-rays.
Class II (usually called Basic)
Includes basic procedures — such as fillings, extractions, and periodontal treatment, such as “deep cleanings” and gum surgery — that are sometimes reimbursed at a slightly lower percentage (for example, 70 – 80%).
Class III (usually called Major)
For major services, such as crowns and dentures. These services are usually reimbursed at a lower percentage (for example, 50%).
- May have a waiting period before services are covered.
Class IV (Orthodontics)
These services are often reimbursed at 50% up to the lifetime maximum.
Limitations and Exclusions
Dental plans are designed to help with a portion of your dental expenses. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. These limitations and exclusions may limit the type or number of procedures covered, or the number of visits, or may impose age limits.
“Can I use my HSA to pay for out of pocket dental work?”
Here’s our short answer: Yes, most dental work will be a covered expense for your Health Savings Account (HSA), however, there are some exceptions.
Here is what the IRS says about dental expenses in regards to your HSA:
“You can include in medical expenses the amounts you pay for the prevention and alleviation of dental disease. Preventive treatment includes the services of a dental hygienist or dentist for such procedures as teeth cleaning, the application of sealants, and fluoride treatments to prevent tooth decay. Treatment to alleviate dental disease include services of a dentist for procedures such as X-rays, fillings, braces, extractions, dentures, and other dental ailments.”
Here’s what is not considered to be an included expense for your HSA:
“Generally, you cannot include in medical expenses the amount you pay for unnecessary cosmetic surgery. This includes any procedure that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. You cannot include in medical expenses amounts paid to whiten teeth.”
For a full list of eligible medical expenses for your HSA, please refer to the IRS publication 502. Or you can just click on this link: http://www.irs.gov/pub/irs-pdf/p502.pdf.