Dental Insurance – What You Need to Know

Dental insurance is a type of healthcare coverage that covers the cost of dental procedures. It typically comes with premiums, copays, and annual coverage limits. It may also include deductibles and coinsurance.

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Whether you want to save money on routine preventative care or major dental work, there are options for everyone. Find a plan that fits your needs by comparing prices from dentists near you.

Preventive care

Good dental health is important for overall well-being, but it can be expensive. Dental insurance can help reduce the costs of routine exams, cleanings and X-rays. It can also cover some basic restorative services, such as fillings and tooth extractions.

Many employers offer dental coverage as part of their benefits packages, and individuals can purchase dental plans through the state marketplace/insurance exchange or directly from a health insurance company. There are a variety of types of dental plans, including indemnity plans that pay a fixed amount for procedures regardless of which dentist you use and managed care plans such as Preferred Provider Networks (PPOs) and Dental Health Managed Organizations (DHMOs).

To determine the type of dental plan that is right for your family, consider the type of dental work that you need, and how much you can afford to spend on a premium. You should also look at the plan’s deductible, co-payments and annual maximum benefits.

Basic care

Dental insurance helps cover the cost of basic procedures like X-rays and fillings. It also covers the costs of major care procedures such as tooth extractions and implants. These procedures can be very expensive, and it’s important to compare plans to find the one that’s right for you. Look beyond the monthly premium and consider the deductible, coinsurance, and maximums.

Some dental insurance plans have a deductible that must be met before the plan starts paying for coverage. This deductible is typically low – $50 for an individual or $150 for a family each year. Some preventive services are excluded from the deductible requirement.

Plans vary by type (DPPO vs DHMO) and insurance carrier. Some have large provider networks while others, such as DHMOs, require you to visit only participating dentists. Depending on your needs, you may want to consider a plan with a smaller network if you’re more concerned about cost than loyalty to your dentist.

Major care

While most dental plans cover preventive and basic services, some also provide coverage for major restorative procedures. Knowing how your plan classifies these treatments will help you determine whether a particular policy meets your needs and budget. The NADP lists more than 240 insurance carriers that sell private dental insurance in the US.

Many dental policies provide coverage for basic services at a rate of 70 to 80% (using either a “customary and reasonable” or a table of allowances calculation). The remaining cost is paid by the plan member. Some insurance plans also require a modest copayment when these services are provided.

If you’re looking for a plan that will pay the most on major services, look for a DPPO or DHMO (Dental Preferred Provider Organization or Dental Health Maintenance Organization) with a large network of dentists. This will increase the likelihood that your favorite dentist is in-network.

Co-payments

Many dental insurance plans have a co-payment or percentage of the total cost that the patient pays for procedures. This is typically listed as a “coinsurance” in the plan details. Some plans also have limits on the number or amount of procedures that can be covered in a year, such as two cleanings per year or fillings on multiple teeth.

Other limitations include time and frequency limits on preventive care visits, such as twice per calendar year or once every six months. Dental plans may also have limitations based on the type of procedure, such as crowns or bridges.

Choosing the right dental plan can be confusing, but a little research simplifies the process. When searching for plans on the Marketplace, look at premiums, deductibles, and copayments to compare costs. Also consider whether you want a Preferred Provider Organization (PPO), Dental Health Maintenance Organization (DHMO), or discount plan.

Deductibles

A deductible is the amount that you must pay out of pocket before your dental insurance begins paying. Most plans have a low deductible, usually $50 per individual or $150 per family each year. Many also have coinsurance, which is the percentage of costs that you must pay once you meet your deductible. This is typically 20 to 80% of the total cost of services.

Another aspect of a plan to consider is the annual maximum. This is the maximum amount that your dental insurance will pay in a calendar year. This is a great way to help you budget for your dental care.

Different types of dental insurance policies have different deductibles, copayments and coverage limits. These factors can make a big difference in your cost and what benefits you receive from your policy. Some plans also have lifetime maximums, which are limits on the amount of coverage you can get over your entire life.

Maximums

The annual maximum of a dental insurance plan refers to the total amount of money that the insurance company will pay for covered procedures in a given period, usually a year. This limit is typically determined by an average fee schedule, which may be lower than actual charges by area dentists. While high annual maximums might not be ideal for individuals who require minimal or no dental treatments, they can help make major services more affordable.

The maximum amount of coverage on a dental plan resets at the beginning of each benefit year (also known as a “plan year,” “coverage year” or “policy year”). While some insurance companies allow you to roll over unused maximum amounts from one year to another, most will not.

There are some dental insurance plans that do not have an annual maximum, but these are generally more expensive. It is important to understand how annual maximums work, as well as what does and doesn’t count toward them, so that you can get the most out of your benefits.