Dumb question: new policy, want to maximize advantages

[theundecided]

I have been independently contracting and so I have a totally new self-purchased plan with BCBS that’s an all-in-one with medical, dental, and vision that started in January. (In 2023 I had another provider) I’m now being offered a full time position with included benefits that will start next month at which time I’ll cancel my self-purchased plan.

So basically my plan is to maximize my current coverage and do all the stuff I’d normally do later in the year like get an eye exam and new frames. I’d like to do the same with dentistry. But I’m wondering if there’s some “catch” that I’m not aware of. Like, since this plan is only a few weeks old will I be denied maxing out my dental benefit in the first month? My dental coverage is like $1,000 so basically one crown and I’m spent for the year. (In my experience this is always how it happens. I need some minor work and hit the limit after a couple of visits but I’ve always been on an employer plan and didn’t actually get to the dentist for a few months after the plan started)

Any advice on what I can reasonably expect BCBS to pay for dental/vision during the first 60 days of a new plan? I have to assume that they expect I’d stay with them the full year (to offset their expenses) but my contract is month to month so technically I could have signed up for January, gotten a bunch of services, and then canceled.

I feel like there’s probably a catch like 100% of benefits aren’t available for 90 days or something but maybe they’ll allow a certain amount now. (I didn’t use any benefits at all in January)

 

[ngocvncom]

@theundecided 100% of benefits are available to use the first day of a policy. There’s no such thing as time limits to use particular benefits. Never has been.

 

[theundecided]

@ngocvncom Thank you! I just wanted to ask so that I don’t get charged back later or something. I’m off to schedule appointments!

 

[bean]

@theundecided For dental, there is no ramp up of benefits through the year. Your full max benefit is available on the first day of your plan year.

You do need to watch out for waiting period. For self-insured plans bought through exchanges, there can be waiting periods for basic (fillings, extractions) and/or major services (crowns, bridges). If there are waiting periods, you'll need to ask how endo, perio and surgical are covered - basic or major. That can make a difference on how you use your coverage.

 

[theundecided]

@bean Thank you for this! Is that waiting period detailed in the plan documents somewhere that I should be looking for? Or ask the dentist’s billing team to look for? I think all I’ll need in the next month is a cleaning but I have a small chip on a molar that I’d love to apply the money toward if I can (assuming later it’ll need to be a crown but my next insurance package can cover that if needed).

 

[bean]

@theundecided You’re welcome.

The waiting period, if it exists, will definitely be in the plan documents. You need to understand the limitations of your own plan.

The dentists office should also do an insurance breakdown to understand your benefits, but mistakes happen. At the end of the day, you are responsible for any remaining amounts that insurance doesn’t pay and non covered items.