Dental insurance covers dental treatments and is actually easier to understand than medical insurance. The purpose of it is to counterbalance the costs of dental care. Dental insurance focuses on preventative measures that help patients maintain good oral health. The bottom line is that treating illnesses as soon as symptoms arise prevents them from turning into more complex issues. Of course it’s not always this simple. At times more severe problems are diagnosed. Dental insurance then covers at least a portion of the treatment, so a patient is never responsible for a full bill.
Dental insurance is a great benefit. It often covers preventative care at 100% and lowers out-of-pocket costs. While it is separate from medical insurance, many employers offer it in their benefit package (just like vision insurance). About 75% of Americans have dental insurance. Nevertheless, many of them do not know how it actually works or what it covers. Let’s answer some common questions.
What is Covered By My Dental Insurance?
Most dental insurance plans use the structure of 100-80-50. What does it mean?
- Preventative care, so routine exams and regular cleanings are covered at 100%
- Basics treatments like fillings, root canals, tooth extractions, treatments for gum disease are covered at 80%, and
- Major procedures that involve crowns, dentures, bridges, or other prostheses, are covered at 50%.
A deductible, which is the amount you must pay before insurance coverage begins, may apply to basic and major treatments. As stated above, diagnostic and preventive services are usually free to patients.
Now that we’ve talked about the things covered, let’s focus on treatments not covered by insurance. They often include:
- Select procedures: while this is different depending on your plan, some dental insurance providers do not cover certain procedures like orthodontics.
- Cosmetic procedures such as teeth shaping, contouring and whitening as well as veneers may not be covered by dental plans. The reason is that they are meant to simply improve your look and are therefore considered medically not necessary.
- Certain pre-existing conditions like missing teeth may also not be covered by some policies.
It’s important to remember that not all dental plans are the same, so you should always check with your provider about what exactly is and isn’t covered. You can also inquire with your dentists’ office as they prepare your treatment plan.
Terms To Know
While reading about your dental insurance, you may encounter various important terms. Below we explain some of them:
- Coinsurance/Copay: A portion of a payment for a specific service that is paid by the patient (insurance holder).
- Deductible: A portion of the cost that needs to be paid by the insurance holder (you) before the provider payments begin. If your plan covers regular check-ups, then your deductible would begin with restorative work. Your insurance provider will pay all pre-established percentages of all your future bills once you meet your deductible.
- Dual coverage: It refers to having more than one dental plan through your spouse, another job, parents or other means. Dual coverage is not the same as double coverage or paying over 100% of expenses. It does, however, influence the overall out-of-pocket costs for the patients, by reducing them.
- In-network dentist: These are the specialists who are seeing patients with your insurance plan. They have agreed to accept pre-established costs for specific services. If you’re visiting an in-network dentist, you will pay less than when you go to an out-of-network specialist.
- Waiting period: Refers to the time you wait for your benefits for full or partial treatment to begin.
- Annual maximum: This is how much the insurance provider will pay altogether for your coverage during one year (12 months). How does that work? Let’s say your annual maximum is $1,500. In that case you are responsible to pay for all additional costs once your dental insurance pays their $1,500 for your treatments. Remember though that only up to 4% of Americans exceed their annual maximums.
The Cost of Dental Insurance
How much you will pay monthly for your dental insurance will largely depend on several factors:
- Your insurance provider
- Your location
- Your chosen plan (HMO, PPO etc.)
On average, a person pays $50 for their dental insurance. When you think about it, even if you’re not using your insurance, you end up paying $600 every year for your dental plan.
If you’re looking into more complex treatments and costlier procedures, you’ll need to check your coverage with your provider to find out the total cost you’ll be responsible for. It’s worthy to note that many basic insurance plans don’t cover implants without limitations or exclusions.
How to Pay For a Procedure
To ensure you don’t overpay for your procedure, follow a few simple guidelines:
- Start by familiarizing yourself with your policy. Read it closely to check if your treatment is covered or not. If you’re not sure, give your insurance company a call. They’ll be able to guide you and help you figure it out.
- If you’re booking a major procedure, ask your dental office for a pre-treatment estimate. That will help you figure out how much money you’ll still owe once deductible, coinsurance and policy maximum are all met.
Affordable Care Act
Obamacare, or The Affordable Care Act, declared that pediatric dental care should be considered an essential health benefit. It can be a part of a larger medical insurance plan or a separate policy. At the same time, dental insurance coverage for adults is not required under the ACA.
Contact Kelly Road Dental Now!
If you have questions about your insurance coverage, plan options, treatment costs or if you need estimates, call our Kelly Road Dental Office. We are here to help you whenever you need it! Remember to also schedule a regular check-up visit to keep your teeth healthy!
