Dental Insurance
Dental work can cost a pretty penny – even a basic cleaning can break the bank if you don’t have dental insurance. A comprehensive dental coverage plan could mean the difference between maintaining a healthy smile and living with a mouthful of cavities and gum disease.
Dental Insurance
Dental work can cost a pretty penny – even a basic cleaning can break the bank if you don’t have dental insurance. A comprehensive dental coverage plan could mean the difference between maintaining a healthy smile and living with a mouthful of cavities and gum disease.
Dental insurance is available as an individual policy or part of some comprehensive medical plans. Either way, it can help you budget the maintenance of your pearly whites. Most dental insurance policies are specific about the procedures they cover and what the out-of-pocket costs are. They’re also usually straightforward to understand.
We Make Dental Insurance Simple & Flexible
Dental insurance is available as an individual dental plan or part of some comprehensive medical plans. Either way, it can help you budget the maintenance of your pearly whites. Most dental insurance policies are specific about the procedures they cover and what the out-of-pocket costs are. They’re also usually straightforward to understand. Below are details to help you decide which plan is worth it for you.
Private Dental Insurance: The Basics
First, you’ll choose a plan based on the dentist you want to see and how much you can afford. If you already know which dentist you want, and they happen to be in the company’s network, or if you don’t have a dentist in mind and want to choose from the dentists in the network, you’ll have a chance to choose a less costly plan.
On the other hand, if you have a dentist and they’re not in the insurance company’s network, you can still use the insurance for procedures, but you’ll need to pay a much higher premium to see them.
Monthly dental coverage premiums depend on a few main factors:
- The insurance company
- Where you live
- The type of plan you choose
Dental Insurance Categories
Dental insurance policies range from individual and group insurance to family and even discount plans. They come in three categories, which are outlined below.
Health Maintenance Organization (HMO)
Health maintenance organization (HMO) dental plans charge monthly or annual premiums and are generally the lowest costing of the three types. However, these plans are restricted to a network, so you won’t have the option to see a dentist outside of the network. You may also need to reside within the area where the HMO plan is offered.
Preferred Provider Organization (PPO)
Preferred provider organization (PPO) dental plans are among the most common type of dental plans available. In this structure, dentists join a PPO network and negotiate their fees with the insurer. Under this plan, you can choose to see an out-of-network dentist, but you’ll have to pay a higher out-of-pocket cost. While PPO plans can be more costly due to the administrative charges associated with them, they provide a higher level of flexibility due to their increased network options.
Indemnity Dental Plans
Indemnity dental plans – also referred to as fee-for-service plans – are less common and more expensive than the other types of plans available. In this structure, insurers set a cap on the amount of coverage they offer for a variety of procedures. While the American Dental Association sets this customary amount, if your dentist’s charges are higher, you’ll be required to pay that amount instead, 100 percent out-of-pocket.
Furthermore, most companies that offer this type of plan ask you to pay 100 percent of the cost for whatever procedure you have done and then file a claim for coverage. If the claim is approved, the company will reimburse its portion of the cost. The most significant benefit to using this type of plan is that there’s no network, so you’re free to choose whatever dentist you prefer without worrying about whether they’re covered.
Waiting Periods
Most dental insurance plans have a waiting period to endure before any standard procedures are covered. These waiting periods typically range from six months to a year for standard procedures and up to two years for major dental work. They’re set in place by companies who want to ensure they’ll profit from their new accounts. They’re also meant to keep new customers from applying for new policies to cover impending dental work.
Deductibles, Copays, and Coinsurance
Deductibles and copays are similar in that they’re out-of-pocket charges required at the time of a procedure. The difference is that a copay is a set amount, while a deductible is a minimum amount that must be paid before the policy will cover it. Once the deductible is met, the policy will only cover a percentage of the remaining cost. This remaining balance can range from 20 to 80 percent of the bill and is the patient’s responsibility to cover. This balance is referred to as coinsurance.
Yearly Coverage Maximums
Most dental insurance policies put a cap on their annual coverage amounts. In general, the higher the monthly premium you’re paying, the higher the yearly maximum will be. Once patients reach the annual maximum, they must cover 100 percent of the remaining dental procedures.
If you’re looking for more information on dental insurance or need help choosing the right plan for you, contact us to explore your options and learn even more.