Dental Insurance

How Does Dental Insurance Work?

Dental insurance policies help many people effectively save for the cost of maintaining a great smile. Compared to medical insurance, understanding dental insurance policies is a breeze. Most Policies are straightforward and specific regarding which procedures are covered and exactly how much you have to pay out of pocket. Dental Insurance is available as part of medical insurance plans or as a stand-alone policy.

Things to know:

Dental insurance covers issues related to the teeth and gums, as well as preventative care such as annual cleanings.

Not all procedures are covered; for example, cosmetic procedures, such as crowns or whitening, are not.
Deductibles, co-pays, and coinsurance will apply, and many policies have annual coverage maximums that are relatively low, ranging from $750 to $2,000 in many cases.

Dental Insurance Breakdown

Selecting a plan based on the providers (dentists) you want to be able to choose from and what you can afford to pay.

If you already have a dentist you like, and they are in the insurance company’s network, you’ll be able to option for one of the less expensive plans.
If you don’t have a dentist at all, you can choose from the dentists who are in the network and again have the option of a less expensive plan.
If your existing dentist is not in the network, you can still get insurance, but you’ll pay significantly more to see your dentist than an in-network dentist. This will cost so much more that you may not have any chance at coming out ahead by being insured.

The monthly premiums will depend on the insurance company, your location, and the plan you choose. For many people, the monthly premium will be around $50 a month. This means that you’re spending $600 on dental costs each year even if you don’t get any work done.

Waiting Period for Dental Insurance

Some dental Insurance policies have waiting periods from 6 to 12 months before any standard work can be done. Waiting periods for major work are typically longer and can be up to two years. These periods are set in place by insurance companies to guarantee that they profit off a new account and to discourage people from applying for a new policy to cover impending procedures.

Deductibles, Copays, and Coinsurance

An insurance deductible is the minimum amount that must be paid before the insurance policy pays for anything. For example, if the deductible is $200, and the covered individual’s procedure is $179, the insurance does not kick in and the individual pays the entire amount. Copays, which are a set dollar amount, may also be required at the time of the procedure.

When a dental deductible is met, most policies only cover a percentage of the remaining costs.

The remaining balance of the bill paid by the patient is called Coinsurance, which typically rangesfrom20% to 80% of the total bill.

Costs and what procedures are required may also differ based on the patient’s age. Seniors on Medicare, for instance, will have a different definition of what constitutes the best dental insurance possible than other age groups.

What is Deductible?

A deductible is the minimum cost that must be paid by the patient before your dental benefits kick in. In a plan that covered routine maintenance exams your deductible would begin with any restorative work completed. After the deductible is met, your insurance should pay the established percentage of any further bills.

How Dental Insurance Categorizes and Pays for Procedures

Dental procedures covered by insurance policies are typically grouped into three categories of coverage: preventative care, such as annual or semiannual office visits for cleaning, X-rays, and sealants.

Basic procedures are treatments for gum disease, extractions, fillings, and root canals, with deductibles, copay and coinsurance determining the patient’s out-of-pocket expenses. Most policies cover 80% of these procedures, with patients paying the remainder. Major procedures such as crowns, bridges, inlays, and dentures are typically only covered at 50%, with the patient paying more out-of-pocket expenses than for another procedure.

Every policy differs in terms of which procedures are categorized as preventive, basic, and major, so it is important to understand what is covered when comparing policies. Some policies classify root canals as major procedures, while others treat them as basic procedures and cover much more of the cost.

Patients who may need costlier procedures should pay particular attention to the details of dental insurance policies. For instance, a single dental implant can cost $3,000 to $6,000. Many basic dental insurance plans don’t cover implants, and those that do come with limits and exclusions. With that in mind, many consumers choose dental insurance that will cover implants.

Do I have to choose a dentist within my network?

To use your dental benefits, you must use an in-network dentist. Check to see if your current dentist is covered by your plan before signing up.

Can I use my dental Insurance immediately?

Most dental policies require a six to twelve month waiting period for any restorative work. Routine exams and cleanings should be covered immediately.

Dental Insurance Does Not Cover Cosmetic Procedures

Most dental insurance policies do not cover any costs for cosmetic procedures, such as teeth whitening, tooth shaping, veneers, and gum contouring. These procedures are meant to simply improve the look of your teeth, they are not considered medically necessary and must be paid for entirely by the patient. Some policies cover braces for a lengthy waiting period.

Yearly Coverage Maximums

Though most Medical Insurance policies have yearly out-of-pocket maximums, the majority of dental policies cap the amount of annual coverage. Coverage maximums typically range from $1,000 to $2,000 per year. Generally speaking, the higher monthly premium, the higher the yearly maximum, they must pay for 100% of any remaining dental procedures. Many insurance companies offer policies that roll over a portion of the unused annual maximum to the next year.