what is dental insurance? it is a form of health insurance for your mouth. And just like general health insurance, some dental plans offer more basic coverage while others offer more comprehensive coverage. Generally speaking, a basic dental plan covers preventive care, such as checkups, cleanings, X-rays, and some basic procedures, such as fillings for cavities. full coverage plans can cover much more, and often at a lower out-of-pocket cost to you. for example, they may cover a broader range of preventive procedures, such as fluoride treatments and sealants, and may cover those treatments in full or with only a small copay. In addition, a full coverage plan (such as those offered by Guardian) can cover other types of procedures, including:
- Basic restorative care: this includes fillings, extractions, and non-routine x-rays
- major restorative care: bridges, crowns, dentures and the like
- orthodontic treatment: braces and other types of teeth aligners
Most dental plans have a network of providers
Most of the plans you’ll find are either a dental hmo or a dental ppo. In a DHMO, you must see an in-network dentist, and because their networks are limited, you probably won’t be able to see your current dentist; the trade-off is generally lower costs and a simpler fee structure.
Reading: How to obtain dental insurance
A dppo also has a network of dentists, but generally allows you to go out of network to see another dentist. But if you go with a large insurance company as your guardian with a large network of providers, your current dentist may be “in-network.” It’s almost always worth seeing a network dentist because with a dppo the insurance company negotiates in-network discounts on their behalf. For example, if your dentist normally charges $100 for a filling, when he or she is in-network, they may only charge $60-$70, even if she hasn’t met her deductible yet.
don’t want to be limited by a network? There is another type of coverage, indemnity plans, which reimburse you for a portion of your dentist’s expenses; however, you must first pay the bill and file a claim. these plans can also be expensive and somewhat harder to find than a dppo or dhmo.
the preventive/basic/major coverage formula
You may see a plan described as having 100/75/50 coverage. This means preventive care (checkups and cleanings) is covered 100% (usually you don’t even pay a deductible); basic procedures, such as fillings and extractions, are covered at 75%; and major procedures such as crowns, bridges and root canals are covered at 50%. There are variations on this formula, and some procedures may be considered “core” in one plan and “major” in another.
deductibles, limits and waiting periods
Like health plans, dental plans typically have a deductible, an amount you must pay out of pocket each year before the insurance company begins to cover its share of the costs. but it is relatively low, usually around $50 for an individual and $150 for a family. While a health plan will limit the most you can pay out of pocket, dental plans typically limit the total amount they will pay for care: $1,000-$2,000 per member per year. any dental expenses that exceed your plan’s maximum cap are your responsibility. Finally, most plans also have a waiting period before they cover major procedures like crowns.