Insurance can sometimes feel a little confusing, and dental insurance is no exception. It’s hard to know what to know about dental insurance. But understanding your dental insurance plan will help you keep your teeth strong and healthy, as well as help prevent oral issues in the future. And because dental care is an important part of health care, dental insurance can pay off for more than just your mouth. So it pays to know about dental insurance.
“The signs and symptoms of more than 120 medical conditions can be detected first by an oral exam of the mouth, teeth and gums, which is why the dentist’s chair is a good place to start if anything out of the ordinary should arise pertaining to your oral health,” said dentist Gary Glassman. Your insurance can help you make that happen—here’s what you need to know about dental insurance.
“The signs and symptoms of more than 120 medical conditions can be detected first by an oral exam of the mouth, teeth and gums …”
—Gary Glassman, DDS
What Dental Insurance Covers
In most cases, dental insurance plans are divided into three levels:
- Preventive care. This level includes regular exams and cleanings.
- Basic care. Services such as fillings and extractions are included at this level.
- Major care. Care at this level includes more invasive procedures such as root canals, oral surgery, and sometimes bridges or crowns.
The level of dental insurance you decide to purchase has a lot to do with your oral history. If you tend to have weak teeth that need a lot of work, you should consider major care levels of insurance, for example.
How Dental Insurance Plans Work
It’s important to review the different options to find the dental insurance that works best for your needs. Some dental insurance plan options include:
- Preferred provider organization (PPO). Under these insurance plans, you have access to a network of providers who have agreed to accept lower fees for procedures. You can visit providers outside the network, Glassman said, but you might not be able to take advantage of your maximum benefits. These are generally the most popular plans because of the lower prices.
- Dental maintenance organization (DMO or DHMO). These insurance plans contract with dentists to provide lower rates, and you must see an in-network dentist. Some DMOs don’t have a cap on annual benefits.
- Indemnity plans: Also known as fee-for-service or fee schedule plans, any dentist is covered under this option. These insurance plans have specific reimbursement rates for each covered service in or out of network, and tend to have an annual maximum.
Networks for dental insurance work much the same as they do for your health care physicians: In-network dental providers who are included in your dental insurance plan are likely to be more affordable, while out-of-network dentists may not be eligible for your maximum benefits.
What Your Dental Insurance Will Pay
Dental insurance generally follows the “100-80-50” rule, Glassman said. This usually means:
- Your insurance coverage will pay for 100 percent of preventive and diagnostic services including checkups, cleanings and X-rays.
- 80 percent will be covered for necessary work such as fillings.
- 50 percent will be covered for crowns, bridges and other major procedures.
What’s covered under each percentage will vary by the insurance plan you decide to purchase, so be sure to review your benefits carefully. In addition, when possible, work with your insurance carrier in advance of a major procedure, to determine how much it will reimburse for your procedure and to avoid sticker shock. In most cases, the dental office will figure out what’s covered and what you will be billed for.
No matter which dental insurance plan you choose, it’s important to pick one that best suits your needs and gives you the most peace of mind, Glassman said. Reviewing your options carefully will help you get the best fit.
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