How Can I Maximize My Insurance Benefits? What You Should Know

If you’re interested in getting orthodontic treatment for yourself or your child at Molly Hottenstein Orthodontics, you may be wondering if you can use your insurance plan to cover the cost. Learn more about how to best use your dental insurance in Wyomissing below. 

1. See An In-Network Dentist When You Can 

Most dental plans use a PPO model. This means that in-network dentists that partner directly with the PPO will offer lower overall costs for treatment, since more of each procedure will be covered by insurance. You can still see out-of-network providers, but may face higher out-of-pocket costs.

At Molly Hottenstein Orthodontics, we have partnered directly with a number of major insurers in Wyomissing, including BlueCross BlueShield, Cigna, MetLife, Aetna, and Cigna. Give us a call now at (484) 258-2299 to confirm your insurance coverage and get started today. 

2. Get Routine Preventive Care Twice Per Year

Preventive care like oral exams and teeth cleanings are typically offered twice a year free of charge by most dental plans. You’ll also get a free set of annual x-rays. Take advantage of this to maximize your benefits, and to ensure you’re keeping your mouth healthy throughout your orthodontic treatment.

3. Know The 100-80-50 Model And How It Affects Orthodontics

Unfortunately, “full coverage” dental insurance doesn’t exist. You’ll always pay some out of pocket costs, and most insurance plans use the 100-80-50 coverage model, which works as follows:

  • Preventive care like teeth cleanings and oral exams is covered at a rate of 100%
  • “Basic” care like fillings and root canals is covered at a rate of 80%
  • “Major” care like dentures and crowns are covered at a rate of 50%

Most dental plans consider orthodontic treatments to fall into the “major” category, meaning the insurer will only cover 50% of the cost of treatment. In addition, some plans will cover this only for kids, not for adults. 

4. Be Aware Of Your Yearly Deductible & Annual Maximum

Your yearly deductible is the out-of-pocket money you must spend before your insurance kicks in, and is usually somewhere between $25 and $250. You’ll hit this easily if you get braces.

However, you also need to know your annual maximum. This is the total amount your plan will pay toward your dental care in a given year. It’s usually set at $1,000 to $2,000. The cost of your braces will likely exceed this limit, so keep this in mind when budgeting for orthodontics.

There also may be a “lifetime maximum for orthodontic coverage” in your plan. While your annual maximum rolls over every year, this maximum does not. After you max out your orthodontic coverage, your plan will no longer contribute toward future orthodontic costs.

Need Expert Orthodontic Care In Wyomissing? Come To Molly Hottenstein Orthodontics

At Molly Hottenstein Orthodontics, we work with major insurers in Wyomissing and can help you understand your benefits. And even if you don’t have insurance, we offer special offers like a free initial consultation and $1,000 off treatment for uninsured patients! 

So don't wait. If you or your child need orthodontic care in Wyomissing, Dr. Hottenstein is here to help. Contact us online or give us a call at (484) 258-2299 if you have any further questions or are ready to schedule your appointment.

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