UNDERSTANDING DENTAL INSURANCE

 

 

The Basics of Dental Insurance

 
 
Dental insurance is  not  like auto or medical insurance.

Dental insurance is not like auto or medical insurance.

Typically, you will obtain your dental insurance from your employer, who will choose it depending on what dental needs the employees in your company have. For self-employed, not working, or if your employer doesn’t offer dental insurance, you may have obtained dental insurance as an individual. No matter how you go about getting dental insurance it is important to understand some basics about how dental insurance works.

Since your insurance company works for you, they will be much more forthcoming about sharing information directly with you. We do encourage anyone concerned with specific details about their dental coverage to call the insurance company directly and ask detailed questions to better understand how their dental plan works. 

Dental Insurance is not like Auto or Medical Insurance, while they both have deductibles and cover cost in certain situations, dental insurance works more like a savings plan. If you have an auto accident your insurance pays for the damage after your deductible is met. Unfortunately your dental insurance does not work this way. If you damage a tooth, your cost will be associated with the plan you (or your employer) chose. Your portion of out of pocket cost will be based on a split or percentage, taking into account allowed service definitions, alternate lower benefits and possible waiting periods. Most of the time patients are frustrated with how little their dental benefits cover when they have treatment needs, especially considering how much they pay in premiums. 

Annual amount of dental benefits have not changed in 20+ years even though the cost of dental services continues to go up every year. Typical plans have an average annual max of $1,500 a year, some may be slightly higher or lower, depending on your insurance plan. We do offer financial options to patients with treatment needs to help with the cost of care. 

Many dental insurance plans include coverage for some services but not all services. A plan may cover sealants but not braces, compared to another that covers braces but not sealants. When a dental plan doesn’t cover certain service this doesn’t mean that this treatment isn’t necessary or that you should hesitate to get a treatment that is recommended.

There are three major types of dental insurance plans, Preferred Provider Organization (PPO), Dental Health Maintenance Organization (DMO/HMO) and Direct Reimbursement; each of these is different and works differently. Our office will file your PPO insurance claims for you, unfortunately a DMO/HMO requires you go to a contracted provider, which we are not.

Click to read about insurance situations to be aware of —>