The holiday season is busy for many reasons. But amid the bustle, some important tasks may have not made it onto your “to-do” list. If you have a Flexible Spending Account (FSA) through your employer’s health plan and you haven’t yet used the remaining balance of your funds for this year, time is running out for you to do so! Some FSA plans end on December 31, while others may extend a grace period to use the remaining amount left in your account or allow for a maximum carry over amount for the next year.
Even if your FSA plan has a grace period, don’t take chances! You’ve already paid for your insurance benefits, so make sure you use them instead of losing them at the start of the new year. If you’re considering a visit to your dentist, this is an ideal opportunity to schedule an appointment for a checkup or treatment covered by your plan.
Other types of dental insurance plans typically have a maximum amount of annual benefits after the deductible has been met. If you’ve met your plan’s deductible for dental expenses this year, you may be eligible for certain services to be covered for free, or at reduced cost. If you need a treatment that meets your plan’s eligibility, scheduling it now — rather than next year, when you’ll have to meet your deductible again — makes much more economic sense!
Types of Dental Expenses an FSA Covers
The basic guideline is that anything that treats or prevents a dental disease is eligible for FSA coverage. However, FSAs can differ depending on your employer’s plan sponsor. To confirm that a procedure is covered, contact your company’s HR department or the sponsor and carefully go over your plan.
Generally, FSAs cover expenses for the following services:
- All diagnostic and preventative services.
- Teeth cleaning.
- Fillings and sealants.
- Fluoride treatments.
- Tooth extraction.
- Inlays and onlays.
- Treatments for gingivitis, temporomandibular joint syndrome and disorder, gum recession, and necessary oral surgery.
Although crowns and bonding are included, they are covered only for restorative purposes — such as to protect a tooth that has had root canal treatment, or a chipped or cracked tooth. Crowns and bonding — including veneers — performed for cosmetic purposes are not covered. Again, check with your company’s HR department or plan sponsor before scheduling treatment to be sure you understand what is and is not covered. Insurance plans can be confusing, so it’s better to ask instead of mistakenly assuming that a procedure is covered, then be billed for it! The same is true for other types of dental insurance plans.
Know Your Dental Insurance Benefits
Our blog post — “Use It or Lose It: Three Things You Need to Do to Get the Most Out of Your Dental Insurance” — provides this easy-to-follow guideline.
First, how do you know if you have “use it or lose it” insurance benefits? Get information on your maximum benefits available (MBA) and your explanation of benefits (EOBs). To do so, locate the full explanation of your dental benefits — whether online or on paper. Before looking over everything in your EOBs, search just for your MBA, which is the maximum amount of money your dental insurance will pay for a variety of dental work in the span of a year — keeping in mind that anything not used by the end of the year does not roll over into the next year, and is lost.
Next, collect your EOBs sent from your dental insurance carrier after all of the dental work you have had performed over the year, and review them to see how much your dental insurance has paid. Totaling this amount and comparing it to your MBA will reveal how much is left that you can use toward dental work by the end of the year. EOBs and other insurance documents can often be unclear, however, so you may want to save yourself the trouble and simply call your dental insurance carrier to ask how much of your MBA is left.
Use Your Benefits for This Year and Plan for Next Year
Earlier, we mentioned the importance of using the benefits you’re entitled to by the end of the year to avoid having to pay for the same service(s) at the start of the new year, when, for many types of plans, you’ll need to pay through the deductible first. But this is also a great time to plan and schedule your visits for next year! Consider these options to make the most of your dental plan:
- Visit your dentist for one of your semiannual dental appointments to receive a teeth cleaning and other preventive dental work. This is one of the easiest ways to maintain your oral health and to take advantage of your dental benefits, as most insurance plans will completely cover preventive dental appointments.
- Discuss dental plans for the remainder of the year at appointments in the summer or fall months, so you can plan and know what to expect. This helps ensure that there won’t be a scramble to use up your insurance benefits come December, along with everyone else.
- Make sure you know what’s covered by your dental insurance and which treatments are not covered. This will help you determine how to effectively plan out your appointments for the rest of the year and into next year. Your dentist office should be able to provide information about what your insurance plan covers, but you can also directly call your insurance provider or visit its website to learn details.
And, of course, talk to your dentist, who is your partner in oral health! Knowing what treatments to expect over the coming year can help you get the most benefits from your insurance plan, no matter what type you have!
At NK Family Dental, it is our mission to provide the highest quality and most compassionate oral care to our Chicago patients, including both dental and periodontal services. Our practice is trusted for advanced oral surgery procedures and comfortable root canal treatment.
Our dental specialists include our general dentist, Dr. Nilofer Khan, our endodontist, Dr. Sabek, and our periodontist, Dr. Amir Danesh. Dr. Danesh is a board-certified periodontist and Diplomat of the American Board of Periodontology. He has contributed to the publication of two books, as well as published over 20 papers in prestigious dental research journals.
We understand that the main concern you may have is cost, which is why we accept all major PPO plans for dental insurance and also offer our in-house dental plan. Please see our financing page for more information.