The Basics of Dental Insurance

Information from the Center for Disease Control and Prevention reveals that over 30 percent of American adults suffer from one form of gum disease or another due to untreated cavities. Most Americans fail to seek dental treatments because of a lack of finances. In this post, we’ll talk about everything you need to know about your dental insurance. Having a dental insurance plan reduces the high cost of dental treatments for curative therapies. However, to get the best out of your dental insurance, you must understand your dental policy.

Understanding Basic Dental Insurance Terms
To better understand your dental insurance, you must understand certain terminologies. Some of them are listed below:
Deductible- just like standard insurance policies, a dental insurance plan may include a specified amount you’re required to pay weekly, monthly, or yearly to enjoy the full benefits of such an insurance plan. This specified amount is called the Deductible.

Maximums- this is the maximum amount your insurance plan covers within a specified period (usually a year). Once you exceed this maximum amount, you’ll pay for your dental treatment for the remainder of the period.

Coinsurance- depending on the type of insurance plan you choose, coinsurance refers to the part payment you’re expected to make for every treatment once you reach your Deductible. Most fee-for-service dental insurance benefits plans cover a certain percentage of your treatment cost, leaving you with the remainder to pay.

Copayments: when people opt-in for DHMO plans, they’re required to pay a fixed amount known as a copayment (which covers specific services rather than percentages). This type of dental insurance plan has no annual deductibles or maximums. The insurance company will provide you with relevant information on the covered treatments and the specified copayment amounts.
Annual maximum- this refers to the total amount a dental insurance plan covers for an individual’s dental care within a specified period (usually a year)

Pre-Treatment Estimates: for costly dental treatments, you need to present a pre-treatment estimate to your insurance company. This will give you an idea of the amount your insurer will pay and the amount you’ll pay out of your pocket.

What is Considered as a Basic Dental Care?
Most dental insurance plans cover 80% of basic dental services, including periodontal treatments, sealants, extractions, non-routine x-rays, and fillings. The dental policy will also include the total cost of preventive procedures like routine cleanings, oral exams, sealants, and regular x-rays.

What is not Considered as Basic Dental Care?
Treatments such as bridges, dentures, and crowns are not considered as basic dental care. Therefore, most dental insurance plans cover only 50% of the overall cost of dental treatments that are not regarded as basic dental care, leaving you with the remaining 50%.

What are the Types of Dental Insurance Plans Available?
There are four main types of dental insurance plans:

• Dental Savings Plan/Discount Dental
• Dental Indemnity Insurance
• Dental Health Maintenance Organization (DHMO or HMO)
• Dental Preferred Provider Organization (DPPO or PPO)

The DPPO plans are the most popular dental insurance plans among Americans because it allows them to choose from a wide array of dental specialists and dentists. DHMO plans offer dental services at specified rates and have specific dentists under contract with the insurance company.

In Dental indemnity insurance plans, the insured consumers pay directly to the dentists for their services and later receive some form of compensation from the insurance company. Under the Dental savings plan, dentist specialists offer discounted services to insured consumers. The insurance company pays part of the fees while you pay the remaining directly to the dentists.

What Does a Dental Insurance Plan Cover?
Dental insurance plans mostly cover:

• Preventive care costs, such as routine office visits and cleaning
• Restorative care costs, such as crowns and filling
• Endodontics costs, such as root canals
• Oral surgery costs, such as tooth removal, minor infection drainage, and tissue biopsy

The insurance company does not directly cover dental services such as Periodontics (lesion management, acute infection, root planning and scaling) and prosthodontics (bridges and dentures). Orthodontic dental services, like retainers and braces, are covered by both individual and company policies.

Most dental insurance plans cover 100% preventive care, specific percentages for dental indemnity plans and DPPOs, and copayment dollar amounts for DHMOs.

Preventive care covered by insurance plans may include sealants, x-rays, and oral evaluations. The basic procedures covered by dental insurance plans may consist of periodontal gum disease treatments, root canals, fillings, extractions, and office visits.

How Much Does Dental Insurance Cost?
Dental insurance costs about $350 annually on average and ranges between $10 to $50 monthly. However, you must note that the cost varies depending on the state you reside in. Most dental insurance plans come with coverage limits and maximum annual benefits. This coverage limit is usually between $1000 to $2000. Unlike medical insurance plans, which still covers your bills after your bills reach your deductible amount, dental insurance plans cut off coverage when your bills exceed the annual benefit and coverage limits. You’ll be required to pay the balance out of your pocket.

What are the Questions You Need to Ask Before Picking a Dental Insurance Plan?
To choose the best dental insurance plan that suits your current needs, you need to ask yourself the following questions:

• What dental procedures would I likely need this year?
• How much would it cost if I use an insurance plan?
• How much would it cost if I am to pay for dental care out of pocket?
• How much would I be required to pay for monthly and annual premiums?
• If I’m to have regular cleaning, how much would it cost with insurance? Without insurance?
• What are the annual maximums for the insurance plan? What dental procedures are covered?

Having dental insurance is a good idea. It helps you save on dental procedure costs. Different dental insurance companies are offering different insurance plans that you might sometimes get confused, not knowing which to choose. Be rest assured that at Westerville Dental Associates, we have your best interest at heart. Check out our site for more blogs to help you choose the best dental insurance that suits your needs.