Understanding Dental Insurance

Before you enroll in a dental insurance plan, you should understand how this type of insurance works.

There are many plans to choose from, and you should choose one that helps you lower the costs of dental procedures. Some dental policies are very specific about their terms, copays and the services that they cover.

You may also be able to purchase dental insurance in addition to your current medical plan or separately through a different insurance provider.  Understanding dental insurance is easier if you already are enrolled in a medical plan as they work in a similar way.

You can learn more about dental insurance, the different types available and the types of dental procedures it covers by reading the sections below.

Waiting Periods for Service Coverage

Most dental insurance plans have waiting period policies. You have to wait for the waiting period to be over before you receive coverage for any dental procedure. For basic procedures, the waiting period typically ranges from six to 12 months. Moreover, the waiting period can be as longs as two years for more extensive work.

Waiting period policies are a way that insurance companies use to profit from new patients. Therefore, you should apply for a dental plan that does not have waiting period policies if you need a procedure done in the near future.

Many plans offer coverage as soon as you enroll in them, and there are other ways that you can enroll in a dental insurance plan without having to wait for coverage. You can consider the following alternatives:

  • Insurance through employers:  You may not have to wait for waiting periods to be over to receive coverage if you enroll in a dental plan through your employer. Dental insurance plans that patients acquire through their employers do not tend to have waiting terms for preventative procedures like oral exams, routine teeth cleaning and x-rays. These plans are also known as group plans.
  • Preferred provider organizations (PPO): Preferred provider organization plans have an extensive network of dentists that they work with and do not require a wait time. Depending on the plan that you enroll in, you may not have to wait for non-surgical procedures as well. PPOs are the most common types of dental insurance you can choose.
  • Dental discount plans: Discount plans are different from dental insurance and offer discounts on routine procedures without wait times. These organizations negotiate with their extensive network of dental service providers for discounts on basic procedures. You will only have to cover an annual fee to enroll in these plans, and you can see a dentist at your convenience.

Dental Insurance Fees

Just like a medical health plan, you must pay certain fees for the services that your insurer provides. You also have to pay to cover the costs of procedures that undergo. But the most common fee that you will have to pay is your deductible. You must finish paying for the deductible before you have access to the benefits your plan offers.

It is important that you understand how deductibles work too. For example, you must pay for services that are less than the cost of your deductible. You may also have to pay a co-pay, and you will only receive coverage until you meet your deductible. As for copayments, they are set amounts that you will have to pay before you can obtain any service or procedure.

For procedures that cost more than the amount of your deductible, your insurance will most likely only cover a percentage of the cost. Therefore, you and your insurance each pay for a percentage of the cost. This is called co-insurance. Your insurance may cover anywhere from 20 to 80 percent depending on your plan. You will be responsible to cover the costs of the remaining balance.

Most insurance plans have an 80/20 split where you only have to pay for 20 percent of the cost of your procedure. Make sure that you find a plan that is right for you and also fits your budget. You should consider copays, co-insurance and deductible amounts as they are important aspects of your insurance plan.

Types of Coverage

Depending on the different dental insurance plans that you can pick from, your service providers will place procedure into three different categories. You should research and review what different plans offer and choose the one that best suits your needs.

The three categories for dental procedures are basic, preventative and major. Most dental plans place similar procedures in the preventative category and provide coverage for it. Preventative procedures include routine checkups, office visits for cleanings, x-rays and more.

Moreover, insurance providers place services like treatment for gum diseases, root canals, extractions and fillings in the basic category. Most of these procedures tend to have fees including copayments or co-insurance.

Depending on if you have finished paying for your deductible, and along with the other fees, you will have to pay for a certain amount when you get undergo these basic procedures. Insurance providers offer coverage for up to 80 percent of the cost of basic procedures, so you only have to pay a small remaining percentage.

Major procedures include more extensive work such as bridges and inlays, and it is the last category for services. Due to their extensive nature, you will have to pay more for this type of procedure as they cost more than basic and preventative work.

You should also understand how your dental insurance plan works before undergoing any type of procedure. Your insurance provider may categorize some procedures like root canals in the major category, while other plans may consider root canals a basic procedure.

Additional Things to Consider About Dental Insurance

Besides the essential information explained above, you should consider other important aspects of dental insurance before you decide to enroll in any plan. One of the things you will notice when you review the types of services your dental plan covers is that they do not cover cosmetic procedures.

Services including tooth whitening, veneers and gum countering are not essential nor do they pose a threat for your health. Therefore, dental insurance plans do not offer coverage for these types of services as they are not medically necessary.

You should also keep an eye on policy caps that your dental insurance plan may have. You will have a lower or higher coverage cap depending on your monthly premium costs. Usually, the higher the monthly premium the higher coverage cap you will have.

You must pay for the costs of any dental procedure you undergo once you meet your annual cap. Therefore, you should review your insurance policies to avoid incurring costs that you may not be able to afford if you meet your yearly limit.