All You Need To Know About Dental Insurance

dental insurance and how it works

Dental conditions are often preventable, but regular brushing and flossing alone are rarely ever enough. Regular dental visits are critical to good oral care. Fortunately, with a dental insurance plan, you can avoid having to pay exorbitant out-of-pocket costs.

What Is Dental Insurance?

Dental insurance refers to insurance coverage for dental procedures, but it doesn’t include cosmetic dentistry. Only the dental procedures considered necessary by a dentist or other medical professional are covered by dental insurance.

How Does Dental Insurance Work?

Just as is the case with other types of health insurance, dental insurance plans typically include a deductible, co-pays, co-insurance, and a maximum annual benefit. The following is a brief breakdown of how these features apply to your dental care.

– Deductible: It refers to the amount you are required to pay out-of-pocket before insurance kicks in.

– Co-Pay: It refers to a set amount the dental insurance carrier requires you to pay for certain procedures and services. Your co-pay may count towards your deductible depending on your insurance policy or provider.

– Co-Insurance: It determines the percentage of dental care that you will be required to pay for after meeting your deductible. So, if you have a 25% co-insurance, you will pay 25% of your dental cost while your insurer pays 75%.

– Maximum Annual Benefit: It is the maximum amount paid out by your insurance for each person on the policy during the calendar year.

Your deductible, co-pay, co-insurance, and maximum annual benefit vary depending on the individual policy and type of plan you insurance and the plans

Types of Dental Insurance Plans

Dental policies come in several forms aimed at meeting the different oral care needs of policyholders, just like standard health insurance plans. Today, there are four fundamental types of dental insurance plans with significant market shares, which are:

Dental Health Maintenance Organization (DHMO)

A DHMO provides comprehensive dental benefits to a defined population of enrollees in exchange for a fixed premium each month and pay for general dentistry services mainly under capitation agreements with a contracted dentist network. If you use a DHMO, you will be required to choose a primary care dentist to be coordinating all the dental care for you.

Dental Preferred Provider Organization (PPO)

A PPO is another common type of dental insurance plan that allows you to choose any dental professional in the plan provider’s network. Unlike a DHMO, however, a PPO usually allows benefits for dentists as well as other providers outside the plan’s network. Individuals under PPO aren’t balance billed for the difference between the negotiated fee and the actual fee charged by the dentist.

Dental Indemnity Plans

Dental indemnity plans are those where the risk for claims incurred is transferred from the employer to a third-party insurer for a specified premium and dentists are reimbursed on a fee-for-service basis, and there aren’t any discounted provider contractor agreements where the dentists agree to accept a fee lower than is customary.

Dental Savings or Discount Dental Plans

Discount dental plans are the non-insured dental programs where a panel of dentists offer services to enrollees at a discounted price or discount off their regular charge. The discount plan does not make any payment to the dentists. Instead, the dentists are usually paid the negotiated fee directly by the enrollees.

When it comes to choosing a dental insurance plan, it is always advisable to ensure that you are actually comfortable with any network limits as well as out-of-pocket costs associated with your preferred plan before insurance and what it covers

What Does Dental Insurance Cover?

Dental insurance typically provides three levels of coverage:

  1. Preventive Care: It includes routine oral examinations, cleanings, X-rays, fluoride treatments, and sealants.
  1. Basic Services: Includes fillings, diagnostic X-rays, root planing, teeth and gum pain emergency care, simple extractions, and tool canals.

III. Major Restorative Procedures: Includes crowns, bridges, impacted teeth extraction, implants, denture work, complex oral surgery, sedation of synesthesia, and implants. 

  1. Orthodontic Procedures such as braces are also covered in some policies, but a lifetime maximum and age restrictions – usually 18-years-old and younger – apply.

What Procedures Aren’t Covered by Dental Insurance?

While some dental insurance policies cover orthodontic treatments such as braces as explained above, they are still subject to limits. Here are some other services that aren’t covered under a standard dental insurance policy:

– Cosmetic procedures such as tooth shaping, teeth whitening, veneers, and gum contouring.

– Dental care related to a pre-existing condition.

– Composite or tooth-colored fillings (amalgam fillings are covered).

It is always important to remember that the exclusions will vary between insurance providers, so policyholders should always check their coverage limits with their insurance providers.

How Much Does Dental Insurance Cost?

The cost of a dental insurance plan varies depending on the type of plan, your location, and the amount of coverage provided by your policy. It’s always advisable to get quotes for dental insurance from multiple providers so that you can select the best one based on your needs.

Final Thoughts

Dental insurance helps you take proper care of your oral health without breaking the bank. When shopping around for dental insurance, always remember that different providers will offer slightly different plan types with different benefits and levels of coverage.

Take time to shop around while comparing plan pricing, dental plan benefits, and dentists to choose from. You should also consider each plan’s monthly premiums and out-of-pocket costs. Do thorough research before selecting a plan to ensure that it is the right one for your needs and budget.


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