Key Things To Know About How Dental Insurance Works

With a dental plan, you can take care of your teeth and gums, catch certain health issues early or prevent them altogether, and spend considerably less money on checkups and teeth cleanings. Dental insurance can be confusing, though. For example, some people think it is part of regular health insurance. This post explains what dental policies cover and how to get them.



The Basics of Dental Insurance

Dental insurance is similar to regular health insurance in a lot of ways. You pay premiums, and the insurance plan covers part of your dental costs. Preventive services such as cleanings, checkups, and X-rays tend to be 100% covered.

Insurers typically cover part of the cost for common non-preventive procedures and many major procedures. It's unlikely you would have to pay the dentist in full for fillings, crowns, root canals, or simple extractions under dental insurance.

How To Get Dental Insurance

A health insurance broker can help you get a dental plan. Brokers have access to numerous insurance policies from big and small providers. Real people you talk to work for brokers, and they find plans to fit your needs and circumstances. You can find dental plans, regular health insurance, vision insurance, and other types of insurance for individuals, families, and employees (group plans).

Brokers are an excellent way to simplify a confusing process, but you can also try purchasing dental insurance directly through providers or health exchange marketplaces. Employers often offer dental plans, too. If you are eligible for Medicare, you could seek coverage under a Medicare Advantage plan.

Discount plans are another alternative. Rather than insurance contributing to the costs of care, you get discounts on the dental services you receive.

No matter what method you use to find dental insurance, pay attention to the language in policies as you compare them. Focus on common terms to be sure you understand the scope and limitations of the proposed coverage.

Annual Maximum Benefit

This is the most money that a dental insurance plan spends on care within a benefit period (typically a calendar year). Maximums often run from $1,000 to $2,000 for each person. It is very unlikely you’ll meet your maximum unless you happen to need considerable dental work.

Implants, veneers, full-mouth periodontal surgery treatment, and full-mouth dental reconstruction are examples of pricey procedures. If you believe you might need one of these in the next few years, a health insurance broker may be able to help you find coverage to meet your needs and lessen the financial impact on you. Similarly, dental insurance coverage for braces varies wildly. You do have more flexibility if your braces are deemed medically necessary.

Dental Insurance Deductible

You must pay a specific amount of money before your insurance plan contributes to costs. That amount of money is called your deductible. It should not apply to most or all preventive services since insurance plans usually cover them 100%.

The different non-preventive services have varying deductible amounts. You pay the deductible, and then your insurance company pays the agreed-upon percentage of the rest. Look at the deductible amounts listed with each service on your summary of benefits before you enroll.

Dental Coinsurance

Coinsurance can be extra confusing because some people think their insurer pays the full amount left after a deductible. This is often not the case.

Basic, non-preventive services tend to have 80% coinsurance coverage. What that means in practice is this:

• You pay the deductible.
• Your plan covers 80% of the remaining amount.
• You pay the 20% that is left.

Dental Insurance Waiting Period

There is usually a waiting period before you can get most treatments or expensive treatments such as crowns. The waiting period can be two months up to even a year. Waiting periods typically do not apply to cleanings and regular checkups, though.

Waiting periods protect dental insurers. Otherwise, people might apply to get insurance right after they learn they need an expensive procedure. For this reason, some consumers get their waiting periods waived when they show they have had continuous dental coverage.

Contact a Health Insurance Broker for Dental Plans

Dental insurance functions similarly to health insurance, which means it can be tricky to understand. For more information on how to simplify the process of getting dental insurance, contact the health insurance brokers at Sackett & Associates Insurance Services or get a quote today.