Dental Insurance can be a life-saving health benefit for many people, but it can also be a confusing maze of coverage limits, pre-authorization, and deductibles that you have to navigate. In this guide, we’ll go over some common insurance terminology, explain benefit coverage levels and let you know how you can get the most out of your dental coverage!
The Basics of Dental Insurance
What is Dental Insurance?
Dental insurance, like health insurance, is a policy offered by an insurance company that provides benefits in exchange for a monthly premium. These benefits can fully cover or help lower the cost of your dental treatment. Not all dental insurance plans are the same, so it’s important to understand the basics of dental insurance when you are ready to make an appointment with a dental office.
There are typically 3 common categories of dental insurance: preventive, basic and major. Many plans take the 100-80-50 approach to coverage, which means preventive care is covered at 100%, basic care is covered at 80% and major care is covered at 50%.
If you and your family think just preventive dental care (routine dental care such as exams and cleanings) is sufficient, a basic dental plan that primarily covers that may be enough. If you expect to need more specialized dental work such as crowns, root canals, bridges, implants, etc., then a dental plan that covers more specialized dental care and treatments may be better for you. The more coverage your dental insurance plan offers - the higher your monthly premiums will typically be, but better coverage can help control your out-of-pocket expenses if you end up needing costly dental procedures.
What does dental insurance not cover?
Most dental insurance plans don’t cover purely cosmetic procedures (teeth whitening and veneers for example) or orthodontic treatments (dental braces, clear aligners, etc). Some policies may also exclude pre-existing conditions such as lost or damaged teeth that occurred before you signed up for your policy.
How do I get dental insurance?
There are two main ways you can get dental insurance. Your employer may include dental coverage as part of your overall employment benefits. If so, you will typically sign up after an eligibility period has passed, or during the company’s annual open enrollment. The insurance company your employer works with may offer different types of dental plans you can choose from based on the type of dental care you expect to need and your budget.
If your employer doesn’t offer dental insurance, or if you lose a job or are self-employed, you can look into purchasing a dental plan on your own. You can do this either through a state health exchange if they offer one, or directly from a health insurance company. You can also work with an insurance broker who can help you go through the available plans in your area and select one that best suits your needs.
Insurance Terms to Know
Preventive dental care: Regular dental procedures that are often covered by your insurance at no cost. This typically includes an oral exam every six months, along with certain types of routine x-rays. Annual or bi-annual basic teeth cleanings may also be included in your policy. Children may have additional types of routine care provided as part of their preventive care. This care is offered at no-cost to you (after your premiums) when you choose an insurance plan that includes no-cost preventive care.
Frequency and limitations: These terms of dental coverage tell you what you’re covered and not covered for, and how many times per year you may be covered. For example, you can get a no-cost dental exam and cleaning just once every 6 months. You may also only be covered for limited types of dental care and treatment, from basic to major care.
In-network or out-of-network: Depending on the plan you get, you may or may not be required to see dentists in the plan network. Some policies will provide lower coverage when you see a dentist that is “out-of-network”, or they may refuse to cover any costs at out-of-network providers.
Premium: The amount you pay monthly (or annually) for your dental insurance coverage. Your premiums will depend on how much your employer pays, what type of plan you select, what additional benefits you add on, and other factors.
Deductible: A deductible is the amount of money you must pay out-of-pocket for dental care before your plan starts to share those costs. Plans with a lower deductible will likely cost more upfront in premiums, but less when you start using your dental coverage. A higher deductible plan may cost less on a monthly basis, but you may end up paying more when you start to use it.
Coinsurance: Once you meet your dental deductible, you and your plan start sharing a percentage of the costs for your dental care. This is called coinsurance. The percentage of costs that your insurance will pay will vary based on the plan you select and the type of care (preventative, basic, or major). Some plans also require you pay a small fee at the time of a dental visit. This is called a copay.
Annual coverage maximum: An annual maximum is the dollar limit your dental insurance will pay toward the cost of dental treatment in a plan year. For example: if your annual maximum is $2,000 and your plan has already paid $2,000 in the first 6 months, you will be responsible for 100% of the costs for the remaining 6 months of the plan year.
Dental plans can help you manage your costs and keep up with your preventative care that ensures your dental health. Selecting a plan that works for your needs can be confusing, so work with the HR department or benefits coordinator that can answer all your questions. If you have questions about your coverage, you can find information on your insurance provider’s website, or you can call your dental office and have them check your coverage and explain what the plan will and won’t cover at their practice. Keep in mind that dental plans can change their benefits and coverage levels arbitrarily so things that were previously covered may not be currently covered.
Ready to schedule an appointment with a local dentist in New Braunfels, TX? Our team can walk you through your coverage and help you get the most out of your dental insurance! Give us a call today: (830) 629-8011
For a partial list of insurance plans we accept (subject to change): https://www.smilenewbraunfels.com/insurance-information
