Dental Insurance – What Is Dental Insurance?

Dental insurance covers preventive care, basic and major restorative procedures. Most dental plans have a yearly maximum that caps the amount paid for services.

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When choosing a plan, pay close attention to the annual maximum, waiting periods and other details. Some plans also have a deductible and/or coinsurance. Consider whether you want a PPO or Managed Fee-for Service Plan, or a Discount Plan.

Preventive care

Many dental insurance plans offer a variety of preventive services that support oral health and may help prevent long-term issues. These services can include annual exams, cleanings, X-rays and fluoride treatments. While these procedures are often expensive, dental insurance can bring them within financial reach for most individuals.

Individuals can purchase dental insurance directly from an insurer or through a group plan offered by their employer. Group plans can provide a significant discount, as companies can buy coverage for many employees at once. However, these types of plans are generally limited to a specific network of providers and typically include deductibles, copayments and maximums.

A deductible is the amount that you must pay toward a procedure before the insurance company starts to cover costs. A deductible is usually per individual covered under the policy, although some plans are family-based. Most dental plans also feature a maximum that caps the amount the insurance company will spend on a particular procedure over the course of a year, or sometimes even lifetime.

Dental insurance plans can be managed care plans, such as HMOs and PPOs, or indemnity plans that pay a fee-for-service to any dentist the subscriber chooses. The type of plan you need depends on your budget and the needs of your family. If you are happy with your current dentist, consider a low-cost, entry-tier DHMO or DPPO.

Basic care

When shopping for dental insurance, you should always be aware that the plan you choose may have a number of restrictions, including waiting periods for some services, deductibles and benefit caps. You should also consider the cost of a monthly premium for the specific coverage you’re choosing. Group plans, which are often available through employers, typically have lower rates than individual policies.

Some dental plans are managed care, meaning that they have a network of participating dentists, while others are indemnity plans (they pay a specified dollar amount for a particular service regardless of what the dentist charges). The former type tend to be HMO and PPO plans, while the latter are more likely to be Dental Exclusive Provider Organizations or Dental Point of Service (DEPO and DPOS).

It’s important to know whether or not your dentist is in a plan’s network, as many dental plans have a fee limit that sets a maximum “customary” or “reasonable” charge. The difference between the fee limit and what you are billed by your dentist is your coinsurance.

Another factor to consider is the annual maximum, which is the amount your plan will pay for all services within a year. While most standard preventive and diagnostic treatments do not count toward the annual maximum, it’s important to understand what your plan will cover before undergoing any major procedures.

Major care

Dental insurance is a type of health coverage that pays for some of the costs of dental procedures. Most dental plans follow a basic payment structure: 100% for preventive services, 80% for basic procedures, and 50% for major procedures. However, the specifics of each plan will vary based on the contracts that the insurer negotiates. The amount paid for each procedure may also be influenced by the patient’s age or other factors.

Most dental plans fall into the category of managed care, meaning that they have a network of dentists with which the insurance company has contracted. There are many different types of dental managed care plans, including Dental HMOs (DHMO) and Preferred Provider Organizations (PPO).

Choosing the right plan depends on your needs. If you are young and healthy, a basic plan is a good choice. If you have existing issues, you should consider a full-coverage plan.

Dental insurance tiers categorize procedures into groups, usually by American Dental Association (ADA) code. The ADA codes are used to identify each procedure and the amount that the insurance plan will pay for each service. Each plan has its own tiers, and it is important to know what each tier covers so that you can make the best decisions about your treatment. The tiers also help to control costs by limiting the number of services that the insurance will cover in a year.

Limitations

In the insurance world, most types of policies are designed to pay out more in claims than they take in in premiums. With dental insurance, this isn’t always the case, which means that patients sometimes pay a lot for coverage and may not get much back in return. A number of factors contribute to this, including deductibles, coinsurance and annual limits.

A deductible is the amount that you must pay out-of-pocket for dental services before your insurance kicks in. Some plans also include a maximum annual limit, which is the most that your plan will pay toward any given dental service in the course of one year. These limits are reissued each year and are typically set in place to help insurance companies maintain profitability.

Most dental plans also come with limitations and exclusions, which are carefully detailed in the plan policy and warrant your attention. These can include age restrictions, types of procedures or visits that are only partially covered and services such as whitening and dental implants that are often excluded.

Many dental plans are preferred provider organizations (PPO) or dental health maintenance organization (DHMO). Similar to a healthcare PPO, these types of plans will provide you with a list of dentists that are contracted to accept the insurance company’s fees at a pre-negotiated rate. If you don’t like the idea of being limited to a network, there are “indemnity” dental insurance plans that allow you to choose any dentist. However, these are usually more expensive than a PPO or DHMO plan.