Once a year, usually in the fall, your employer or marketplace account opens a window to review your dental coverage, compare plans, and make changes. That’s open enrollment. It typically lasts a few weeks, and whatever you choose stays in place until the next one.
Dental tends to feel less urgent than medical, so the plan often gets picked in a couple of minutes based on the lowest premium. That quick choice sets your annual maximum, your network, and your out-of-pocket costs for the next twelve months, so it’s worth a little more time.
What changes when you pick a plan
The plan you choose decides which dentists are in network for you. PPO plans let you see most dentists, while others are more restrictive, and that affects whether your current dentist is covered at in-network rates.
It also sets your annual maximum. Most dental plans cap what they’ll pay each year, commonly between $1,000 and $2,000, and a new plan might raise or lower that number.
Plans also differ in their deductibles and waiting periods. Some make you pay a set amount before coverage starts, and some won’t cover certain procedures for months.
Finally, the plan determines what’s covered. Preventive care such as cleanings, exams, and X-rays is usually covered well. Crowns, root canals, and implants are covered less, or not at all.
For the fuller picture of how dental coverage differs from medical insurance, read how dental insurance works.
Questions to ask about any plan
Before you commit, find out what’s covered and at what percentage, whether your dentist is in network, what the annual maximum is and when it resets, and whether there are waiting periods for major work. Once you know those answers, the bill at the front desk won’t surprise you later in the year.
Our guide to choosing the best dental insurance plan goes through each of these in more detail. If network rules are the confusing part, in-network vs. out-of-network dentists explains the cost difference.
If you end up without coverage
Open enrollment is also when some people lose dental coverage. A job change, a plan that drops its dental option, or a child aging off a parent’s policy can all happen this time of year. You can still keep up with your dental care.
The two most practical options are a membership plan and financing. A membership plan charges a flat yearly fee for preventive care and gives you a discount on treatment, with no deductible or annual cap. Financing spreads the cost of larger work over time. Dr. Smile offers both, and the Dr. Smile Membership Plan post explains what each plan includes. For a step-by-step approach, see what to do when you don’t have dental insurance.
Where a fee-for-service practice fits
Dr. Smile is a fee-for-service practice that accepts most PPO plans. Because we aren’t bound by insurance contracts, your treatment options aren’t limited to what a plan prefers. In many cases, out-of-network fee-for-service providers are also reimbursed at higher rates than in-network ones, which can work in your favor. We explain this in why fee-for-service practices offer better care for patients.
After you enroll
Your annual maximum resets every year, and unused benefits don’t carry over, so it pays to plan when you’ll get treatment. How to use your dental annual maximum wisely covers how to time cleanings and larger work.
Dr. Smile works with most PPO plans, offers membership and financing for patients without coverage, and confirms your benefits before treatment begins. You can contact us or find the office nearest you in Newport Beach, San Pedro, Torrance, or Lomita on our location page.