What You Need To Know About Dental Insurance

Keeping your teeth clean and healthy for maximum smile wattage isn’t the only reason to stay on top of your dental health—some oral diseases can affect other parts of your body, even your heart! The cost of regular checkups and unexpected (and expensive) dental problems can add up fast, so it’s important to choose an insurance plan that works for you and your family.

How does insurance work?

If you’re familiar with medical insurance, you already have a good idea how dental insurance works: you pay monthly premiums and insurance covers costs according to benefits listed in the plan. Some plans require co-pays and others rely on a deductible, which is the amount you must pay before insurance kicks in. Some plans use a mix of co-pays and deductibles, so it’s important to read your benefit plan carefully before making an appointment.

What are your options?

As with medical insurance, dental coverage is commonly bundled into employee benefit packages. And under the Affordable Care Act, pediatric dental services are required for all health plans offered on the exchange. But insurance plans vary widely, so it’s crucial to understand the options before choosing. Employer and non-employer coverage options include:

  • Dental health maintenance organization (DHMO): Coverage applies only to in-network dentists, so be sure to check out the list of approved providers before selecting this option. Tip: Many dentists don’t accept DHMO insurance, so it’s a good idea to cross-reference the provider list with review sites such as Yelp.

  • Dental preferred provider organization (DPPO): Coverage applies to dentists both in and out of network. Co-pays and procedures with in-network providers are usually less expensive than out-of-network, but this is a good option if you have a long-time dentist you want to keep.

  • Dental indemnity plan: Coverage is provided for your dentist of choice with no difference in cost.

  • Discount dental plan: If you don’t have dental insurance, this type of plan can at least reduce costs; patients pay for care at an agreed-upon discounted rate.

What kinds of services are covered by insurance?

Preventative and diagnostic care are standard, but the co-pays and coverage percentages usually increase with the seriousness and complexity of the procedure. Services are commonly classified into the following groups:

  • Class I: preventative and diagnostic are (cleanings, exams, X-rays)

  • Class II: basic procedures (fillings, root canals)

  • Class III: major procedures (crowns, bridges, dentures)

  • Class IV: orthodontics (braces)

Insurance plan coverage is structured by class. For example, a plan with a 100-80-50 structure will cover 100 percent of Class I services, 80 percent of Class II services, and 50 percent of Class III services. Orthodontics are typically limited to children under the age of 19 and covered under a separate lifetime maximum. Other services, such as cosmetic procedures (teeth whitening, etc.) are rarely covered.

Don’t forget the fine print

When deciding on dental insurance, be sure to read the entire coverage plan, including the fine print. Some plans require you to submit a treatment proposal, which must be approved before receiving treatment—believe us, the last thing you’ll want to deal with after major dental surgery is a messy insurance claim.

Even worse would be to realize you weren’t covered at all, so also be sure to note if your preferred insurance plan has annual benefits limitations. This means your coverage could be limited by a number of procedures or dollar amount per year, and knowing what those limitations are in advance will help you minimize out-of-pocket expenses.

We’re here to help

At Town Center Dentistry, we will do our best to help you understand procedures and maximize your oral health. In some cases, we may be unable to answer specific questions about your insurance plan or estimated coverage—for that, it’s best to contact your employer’s benefits department or your insurance provider.

Any questions about teeth, however—we’re all ears (and smiles)!