Daunted by Dental Insurance? Here Are a Few Useful Tips

Dental insurance can be a fantastic way to save money while protecting your gorgeous smile from destructive infections, but it’s understandable that some people may need a little help understanding how their policies work. Thankfully, your dentist’s staff will be happy to help you understand your plan and what it will pay for if you call their office with your insurance information before your appointment. Here’s a brief guide to how most dental insurance plans work and how you can make the most of your benefits.

What Does Dental Insurance Pay For?

The exact benefits included in dental insurance plans can vary wildly from policy to policy. Typically, higher monthly insurance premiums are associated with more favorable terms of coverage, but most policies work something like this:

• 100% coverage for routine oral care services like checkups, cleanings, and X-rays. This may also include one emergency exam every year.
• About 80% coverage for minor restorative work like fillings and gum disease treatments like scaling and root planing.
• About 50% coverage for major restorative work like extractions and root canals.
• No coverage for elective and medically unnecessary procedures like most cosmetic dental treatments.
• In some cases, policies may cover orthodontic work like Invisalign, but this may be limited to minors listed as dependents on the plan.

What Restrictions Do Dental Insurance Plans Have?

If you have an HMO plan, you will probably be required to see an in-network dentist to receive any coverage, but the policy may not impose many restrictions other than that. A PPO plan, on the other hand, will usually allow patients to receive coverage if they see any dentist, but it may involve restrictions like a waiting period before benefits take effect, a deductible that must be met before the plan starts paying for anything, or an annual maximum that defines how much money it can pay in a year.

In-Network Vs. Out-of-Network Dentists

An in-network dentist has negotiated with your insurance company so they can provide oral health services at further reduced rates to their policyholders. An out-of-network dentist has not, which means PPO policyholders may not receive as much coverage when seeing them as they would if they saw an in-network dentist. HMO policyholders are typically required to see in-network dentists to qualify for any coverage at all.

There’s no reason to be intimidated when you look at your dental insurance policy. Your dentist will be happy to help you understand your plan and help you maximize your coverage.

About the Author

Dr. Patrick Crowley earned his dental degree at the University of Oklahoma College of Dentistry where he also completed his Advanced Education in General Dentistry residency. He is proud to be a member of the American Dental Association and the Academy of General Dentistry. His office in Edmond offers general, restorative, cosmetic, and emergency dentistry. To schedule your next checkup, contact his practice online or dial (405) 751-5515.