How Dental Insurance Works

If you are considering buying dental insurance, it is important for you to know how it works. You should know that dental insurance plans can assist you in effectively lowering the cost of dental work.

If you already have medical insurance, understanding the details of dental insurance will not be difficult, as it works in much the same way.

Many dental care policies are very specific in explaining what services and procedures are covered and how much you will have to pay out of pocket. You can purchase dental insurance together with your medical insurance or separate from the plans that you have, as a standalone policy. For more information on the different aspects of dental insurance, how it works, the different types of dental plans with no waiting period, how dental insurance categorizes and pays for the dental procedures and more, refer to the sections below.

Waiting Periods

If you are looking for a dental insurance plan, it is important to consider that most policies have a waiting period. The waiting period for basic procedures in most plans can range from six to 12 months. The waiting period for extensive work can be even longer. If you want extensive work done, there is a possibility that your waiting period could be up to two years. Your waiting period is set by your insurance company to ensure that it profit from new accounts.

Due to these wait periods, it is not a good idea to apply for a new policy to cover procedures that will take place in the near future. While there can be extended waiting periods for certain plans, there are some plans that have no waiting periods. Some types of dental insurance plans offer coverage that begins immediately for certain services.

If you are receiving insurance through your employer, you can typically expect to not have any waiting periods for preventative procedures like teeth cleansings, oral exams and x-rays. These plans are known as group insurance plans.

Another category of insurance plans that usually have no waiting periods are preferred provider organizations, or PPOs. These plans have specific dentists in their network and refer you to those dentists with no wait times. These are the most common types of dental insurance plans. These plans may also have programs with no wait times for preventative and non-surgical procedures, as well.

Finally, a dental discount plan is an option that has no waiting periods for routine dental work. While this option is not considered insurance, dental discount plan organizations negotiate discounted prices with dentists in their network. With these plans, you only have to pay an annual fee to see dentists at your leisure.

Deductibles, Copayments and Co-insurance

While insurance is a great way to save money on dental care, you are still responsible for paying specific amounts to your insurer and for your services. In order for your insurance to take effect and start rewarding you with discounts or benefits, you must pay a deductible. It is important to note that if your procedure costs less than the deductible issued to your plan, it is your responsibility to pay for the entire bill. For example, if your deductible is $200 and the cost of your procedure is only $150, your bill will not meet the required amount for insurance to go into effect and pay the bill. You will have to pay the entire amount. There is also the possibility that you will have to pay a copayment. These are the set dollar amount that you pay before your procedure can be done.

In the event that your procedure does exceed the deductible, your insurance company may only cover a percentage of the remaining costs. The amount of your bill that has to be paid by you and your insurer is called the co-insurance. The co-insurance can range from 20 percent to 80 percent of your entire bill. Most co-insurances have an 80/20 split. This means that you are responsible for 20 percent of your bill, while your insurance plan will take care of the remaining 80 percent. Plans can vary in the percentage that they cover.

When finding the right dental plan for your needs, be sure to pay attention not just to the plan’s monthly premium costs but also it its deductible, copayments for services, co-insurance and yearly maximum coverage.

Categories and Procedure Pay

There are three categories that procedures can be grouped into in regard to coverage. These categories are preventative, basic and major. The majority of dental insurance plans cover all of your preventative procedures. These procedures include annual or semi-annual office visits for teeth cleanings, X-rays, sealants and more.

Your basic procedures include treatments for gum disease, root canals, extractions and fillings. These procedures usually have deductibles, copays and co-insurance. All of these factors determine what you will have to pay out of pocket. You can expect basic procedures to be covered up to 70 percent to 80 percent in your dental insurance plan, requiring you to pay the remainder.

The last category is major procedures. These procedures include crowns, dentures, bridges, inlays and more. Because these procedures are extensive, they require you to pay more out of pocket than those in the preventative and basic category.

Depending on your insurance plan, procedures can be classified in different categories. This is why it is important to research different plans and make sure the categories fit your needs. For example, root canals are typically a basic procedure, but there are some plans that categorize them as a major service.

What to Keep in Mind

There are a few more things to keep in mind in regard to how dental insurance works. The first is that you should not expect dental insurance policies to cover any costs for cosmetic surgeries. Tooth whitening, tooth shaping, veneers and gum contouring are procedures that are not covered under most dental insurance plans. These services are simply administered to improve the appearance of your teeth, and therefore not medically necessary.

It is important to note that most dental insurance policies cap your annual coverage amount. Your coverage maximum will usually range from $750 to $2,000 a year. If you pay a higher monthly premium, you will likely have a higher annual maximum. Once you meet your yearly maximum, you will have to pay for the rest of your remaining dental procedures on your own.

It might also interest you: