We are now in 2019! Which we hope is going to be one of the best years yet! The beginning of the year means that dental insurance benefits restart. Dental insurance might be confusing to you, especially with all of those terms such as maximums, deductibles, networks, etc. So we are going to try to cut through some of this confusion and help you understand how dental insurance works.
Dental Insurance is separate from your health insurance and basically helps pay for your dental care. Dental plans offer many different types of coverage, which means they don’t all cover the same procedures and services. Most of them will cover at least routine cleanings and exams, and x-rays. Also, most dental insurance plans will cover fillings, extractions, and even root canals and crowns. Cheaper plans usually won’t cover braces or other orthodontics. The monthly pricing you pay will depend on which plan you choose. This monthly fee you pay is called the premium. We would suggest talking to an insurance agent that can help you get a good dental insurance plan, they will also be able to make sure you understand your plan and that it will cover what you need.
There are different types of dental insurance plans. One of the major types is called Preferred provider organization. This means that the insurance plan will have a list of dentists that will accept these plans for a set amount. If you don’t see your dentist on the list, then none of the dental work you have done at that dentist will be covered by your insurance. To prevent this, make sure you talk to your dentist to see what types of dental insurance they except.
There are also discount plans, which aren’t technically insurance, but some dentists may accept these plans. But basically, if you have one of these cards then you can get services at a discounted rate. These aren’t nearly as popular as the normal dental plans. Once you have a dental plan that is accepted at your favorite dentist, you will need to understand how it works. Most plans use a yearly benefit plan, which means that you have a set amount of benefits in any given year. When you go to your dentist and have work done, you will normally request that the bill is sent to the insurance company. This is called a claim. Once they have approved this claim, it will then be paid. Your dental insurance plan will have an explanation of benefits, which is what is covered by your plan.
There are a few terms that will be helpful to know when you are interacting with dental insurance.
Once you meet your deductible, you will then have to pay a portion of any major procedures you have done. For example, this could be up to 50% of the procedure.
This is the amount of cost for a given procedure.
- Annual Maximum
Most plans will have a maximum amount that your insurance company will pay in a year. Once you hit that amount, the insurance company will no longer cover any of the expenses.
There are certain services or products that your dental plan won’t cover, these are called exclusions.
- Waiting period
Most plans won’t cover major procedures until a set amount of time has passed. For example, teeth replacements usually will require time to pass before they will be covered.
- Pre-existing conditions
Most dental insurance plans won’t cover oral issues that are already in existence. Which means if you go to the dentist and are told you need a root canal and crown, you probably won’t be able to go out and purchase dental insurance that will cover this procedure immediately.
There are many more terms used, but these are some of the most common. We would suggest talking to your dentist if you aren’t sure what type of insurance plan you need. We should be able to direct you in the right direction.