Understanding Dental Insurance Plans: A Comprehensive Guide

The ADA recommends bi-annual dental visits for optimal oral health. But these trips to the dentist can cost a lot of money. Not only that, but some restorative and preventative care procedures can be very expensive. That’s why it’s in your best interest to have dental health insurance. Insurance helps you save money. It also gives you the peace of mind of knowing you don’t have to break the bank whenever you or your loved one needs dental care.

How Dental Insurance Works

Dental insurance helps cover your dental care costs, making it more affordable for you to maintain your oral health. It’s available as part of medical insurance plans or as a standalone policy you buy from a dental insurer or the marketplace. Like health coverage, you can choose a dental plan based on the dentists (providers) you want to be able to pick from and your budget. 

Full or comprehensive dental insurance typically covers portions of the following categories of dental care:

• Preventive care includes regular check-ups, cleanings, and x-rays. These help prevent dental problems from developing and can catch issues early when they are easy to treat. For example, your insurance might cover two cleanings per year.
• Orthodontic care like braces, retainers, or aligners designed to straighten your teeth. 
• Basic and restorative care includes treatments for common dental issues such as cavity fillings and simple tooth extractions. Most dental plans also cover any X-rays needed to complete these procedures. 

Major dental care may require oral surgery and the use of anesthesia. These include:

• Prosthodontics like bridges and dentures
• Root canals or endodontic treatment
• Periodontics like root planning, scaling, and managing acute lesions or infections
• Oral surgery like tissue biopsy, removal of impacted wisdom teeth, and draining minor oral infections
• Some plans will also cover dental implants

Your insurance policy will cover two preventive visits annually. However, if you have an individual policy, you may not have access to prosthodontics and periodontics in the first year of coverage. Most dental plans follow the 100-80-50 coverage structure, which means:

• 100% coverage for preventive care: Your insurance covers the full cost of regular check-ups, cleanings, and x-rays.
• 80% coverage for basic or restorative care: Your insurance pays 80% of the cost for services like fillings and simple extractions while you pay the remaining 20%.
• 50% coverage for major dental care: Your insurance covers half the cost of more complex procedures like root canals, crowns, and dentures, and you pay the other half.

Types of Dental Insurance Plans

Several dental insurance plans are designed to fit different needs and budgets. Let’s break them down:

• Dental preferred provider organization (PPO) plans: PPO plans have a network of dentists you can visit for lower costs. You can still see dentists outside the network, but it will cost more. Dental PPO plans offer flexibility and cover a wide range of services.
• Dental health maintenance organization (DHMO) plans: DHMO plans require you to use dentists within their network. They usually have lower premiums and no deductibles. You choose from the network’s dentists and get affordable care.
• Indemnity plans (Fee-for-Service): Fee-for-Service plans allow you to visit any dentist. They usually have higher premiums and deductibles. You pay upfront for services and then get reimbursed by the insurance company.
• Discount dental plans: These aren’t insurance but offer discounts on dental services from participating providers. You pay a membership fee to get these discounts.

How much you pay depends on the insurance provider, plan, and location. But on average, the monthly premium is around $50. That means you’ll spend about $600 on dental costs every year, even if you don’t get any work done.

Premiums, Deductibles, Copays, and Maximums

Let’s explore some common terms that you’ll likely encounter when comparing dental insurance plans:

Premiums

An insurance premium is the amount you agree to pay in exchange for dental health coverage. It guarantees financial compensation for dental care as long as you pay. 

Deductibles

A deductible is the amount you need to pay out of pocket before your insurance starts to cover certain procedures. For example, if your deductible is $50 and your procedure is $45, the insurance won’t kick in, and you'll have to pay the whole amount. Most plans exempt preventative care from the deductible.

Copays and Coinsurance

A copay is a fixed amount you pay for the dental health benefit. After a deductible is met, many providers only insure a percentage of the remaining costs. For instance, you might pay $20 for a routine cleaning while your insurance covers the rest.

Other plans may offer a certain percentage and let you pay the remaining balance. This is referred to as coinsurance, which typically ranges from 20 – 80% of the bill. Plans won’t have both: PPO plans often have coinsurance, while HMOs have copays.    

Maximum Benefits

The annual maximum is the maximum amount your insurance will pay for dental care in a year. If your plan has a maximum benefit of $1,000, the insurance will cover costs up to $1,000 annually. In this case, you’ll pay the full amount for any remaining dental procedures. Providers may offer policies that allow you to roll over a portion of your unused annual maximum to the next year.

How to Choose the Right Dental Insurance Plan

There are a lot of dental insurance options in the market. So, the question becomes, how do you identify the right one for your needs? Here’s a quick guide on how to go about it:

• Assess your dental needs: Consider the dental services you and your family typically need. Do you mostly need preventive care like cleanings and exams, or do you anticipate major procedures like root canals or crowns?
• Compare costs: Look at the premiums, deductibles, and copays of different plans. Make sure to consider the maximum benefits as well.
• Check the network: Ensure your preferred dentists are in the plan’s network. This is especially important for PPO and DHMO plans.
• Read the fine print: Understand the coverage limits and exclusions. Some plans might not cover certain procedures or have waiting periods before coverage begins.

How to Maximize Your Dental Benefits

To get the most out of your dental insurance:

• Schedule regular preventive care visits: Regular check-ups and cleanings can prevent more serious and costly dental issues. This should be about twice every 12 months.
• Use benefits for major dental work: To maximize your benefits, schedule significant procedures within the same year.
• Minimize out-of-pocket costs: Choose in-network providers and use your insurance plan's preventive care benefits, often with little to no copay.
• Handle unexpected expenses: Set aside some savings for dental emergencies, or consider a plan with higher coverage limits if you anticipate needing extensive dental work.
• Take care of your teeth: Prevention is better than cure. Brush your teeth after meals, floss, drink a lot of water, and eat meals that promote a healthy smile. 

With this guide, you should be able to navigate dental insurance's complexities confidently. If you are a dentist looking for dental office supplies, we recommend checking our catalog. Dental Finds has a wide selection of quality dental supplies for dental clinics.