Understanding Your Dental Insurance

If your employer doesn’t offer a dental insurance plan, there are still other ways you can obtain dental coverage. Maybe you are a member of an alumni association, union, or other membership organization that offers a dental plan? If not, there are still many coverage options available for individuals and families to purchase on their own that are designed to offset the costs of important dental care.

When purchasing a dental insurance policy, regardless of where you obtain your coverage from, you should read it carefully to determine what services are covered. Here are some of the common dental services you’ll likely see noted in your policy:

ExamsA standard preventative dental service, some plans cover up to two exams per year, while others only cover one exam in a 12-month period.
CleaningsSimilar to exams, cleanings are a standard preventative dental service and your plan could cover one or two per year.
X-RaysThere are different types of x-rays that your dentist may recommend. Bitewing x-rays are a common preventative dental service, typically covered once per year. Panoramic x-rays may be considered an additional or major service and subject to different coverage.
FillingsWhen determining coverage for fillings, you may need to consider the type of filling you choose. Your policy could cover a traditional silver filling, but not a composite, white filling that matches your tooth color.
ExtractionsWhen extracting teeth, the procedure could vary from a simple extraction procedure to a more invasive oral surgery. Make sure you know what to expect from both a procedure and coverage standpoint.
Oral SurgeryExtracting impacted teeth is a common oral surgery, but there are other instances where surgery is necessary, such as jaw issues or damage from accidents.
Crowns, Bridges, Dentures, etc.Depending on your dental needs, you’ll want to check your policy for coverage. If you are unsure or have questions about coverage on a particular service, you can contact your provider or agent for clarification.


Dental Insurance Language

Once you know what’s covered, you’ll want to pay attention to how much of the dental service cost is covered. To understand what charges may be coming your way when getting the dental work that you want, you’ll need to understand the coverage terminology in your policy. Here are some insurance terms to look for:

Enrollment feeSome dental policies may charge an enrollment fee for signing up.
Waiting periodThere may be a waiting period noted on your dental policy, which is a period of time that must pass before any benefits will be paid.
DeductibleMost dental plans have a specific dollar deductible. During a benefit period, you personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Some dental plans will apply the deductible to diagnostic or preventive treatments, and others will not.
Co-insuranceMany insurance plans have a coinsurance provision. That means the benefit plan pays a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance. What you pay is called the coinsurance, and it is part of your out-of-pocket cost. It is paid even after a deductible is reached.
Maximum BenefitMost dental plans have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period (usually January through December). The patient is personally responsible for paying costs above the annual maximum.
Limitation and ExclusionsDental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits.

Pre-Treatment Estimate

If your dental care will be extensive, you may ask your dentist to complete and submit a request for a cost estimate, sometimes called a pre-treatment estimate. This will allow you to know in advance what procedures are covered, the amount the benefit plan will pay toward treatment and your financial responsibility.


Selecting a Dental Provider

Once you have dental insurance, you must select a dentist. Depending on your plan, you may need to find one that is included in your dental coverage network. Or your plan may allow you to choose any dentist you wish. Either way, you’ll want to find a dentist that meets your needs. The more you understand about the various dental fields, the better suited you will be to pick a professional that will serve you best.

A general dentist has been licensed to diagnose problems and conditions and can provide treatment. When necessary, they may refer you to a specialized dental practitioner.

Consider the following when selecting a general or family dentist:

  • Find out how long the dentist has been practicing and about the types of professional societies that he or she belongs to. Some organizations require dentists to take education courses to keep up to date on the latest procedures and techniques.
  • Ask about the extent of the dentist’s training in the areas where you need the most assistance.
  • Ask about the referral process.
  • Ask about the type of emergency care offered.
  • Inquire about patient comforts during procedures, such as nitrous oxide and medication.
  • Inquire about the use of lasers as an alternative to drilling or using scalpels.
  • Determine dental costs prior to treatment, including procedure fees, anesthesia fees and facility fees.
  • Make sure the staff is friendly and that the office is close to your home or workplace.

For many, going to the dentist is not a particularly favorable thing to do. However, oral care and regular exams are highly important for overall health as 90 percent of all systemic diseases have oral symptoms. This is why it’s so important to find the right dental coverage and the right dentist, and remove any other obstacle that may prevent you from keeping up with your routine dental exams.

If you have any questions about dental coverage or plan options, our team of agents is here to help. Contact us today!