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6 Things You Should Know about Dental Insurance

Before you buy, we want you to know what to look for!

#1: Regular dental care keeps the rest of you healthy, too.

Woman smiling with white teeth.
Keep your smile white with regular dental check-ups.

Your dentist can spot evidence of several major health conditions, including cancer, diabetes, kidney disease, and osteoporosis. Regular cleanings and preventive care can also help reduce your risk of heart attack and stroke. Doctors are still piecing the puzzle together, but there's a scientific connection between the plaque in your mouth and the plaque in your arteries. Keeping your mouth clean and healthy can lessen your risk for a number of health risks.

#2: There are 4 different types of dental insurance plans.

Before you buy, know which type works best for you.

  • PPO plan. This plan is a good option for people looking for coverage plus flexibility. Much like health insurance, the PPO option lets you visit any dentist in the network for a low rate, and any dentist you want (outside the network) for a higher rate. You will pay a percentage of the cost of service, and your insurance company will pay the rest.
  • HMO plan. This type of plan is usually less expensive than a PPO, and requires you to pick a primary care dentist to visit for all your covered dental services. You pay a co-pay for each dental visit, just like you would for an HMO health insurance plan. Many plans offer free or extra-low-cost preventive services such as cleanings and x-rays. If you need to visit a dentist outside the network, thought, watch out—you may have to pay the entire cost of the visit yourself.
  • Indemnity plan. This kind of plan is also called "fee-for-service." It's basically the same as a PPO plan, but your dentist is reimbursed differently by the insurance company. The same rules and features apply: you must visit an in-network dentist, and pay a percentage of the cost of each treatment procedure you receive. Your plan will probably have an annual limit for benefits, and you might also have a yearly deductible.
  • Discount plan. This kind of plan isn't actually an insurance policy. It's a special program that lets you go to any participating dentist and receive care at a discounted rate. There is usually a monthly or annual fee to join the discount program, but you don't have to deal with claim paperwork, co-pays, or deductibles.

#3: Dental services aren't one-price-fits-all.

With most dental plans (the HMO option excepted), you pay a percentage of what the service would cost without insurance. But some types of procedures are less expensive than others. Here's a basic guide:

  • Diagnostic & preventive care. This is the routine maintenance we all need, from cleanings every six months to x-rays once a year. Most plans offer these services free of charge.
  • Basic services. This is the small stuff that needs fixing every once in a while, like cavities, extractions, and other small repairs. Most plans will ask you to pay 20% of the cost of these services.
  • Major services. This is the big stuff that most of us dread, like bridges, crowns, and dentures. Most plans will ask you to pay 50% of the cost of these services.

#4 Some plans have a waiting period.

Woman at the dentist.
Check-ups and x-rays are usually free when you have dental insurance.

If you're shopping for good dental insurance plans today because a tooth has been killing you for weeks, you're probably especially interested in a plan with a short waiting period. Most actual insurance plans do have a waiting period—most range from 6 months to 12 months, depending on the kind of treatment you need.

Your best bet in this case might be to get a discount plan, get the services you need right away, and then apply for dental insurance afterward.

#5 Stay below your annual maximum.

Most dental insurance plans put a limit on the amount they'll pay on your behalf per calendar year. It's up to you to know what this amount is, and how close you are to hitting it. If you need a lot of work done, start with the most important things and work your way down your list. If you're ever in doubt how close you are to your annual maximum, call your insurer and ask. If you go over your annual maximum, you could be liable for the total cost of dental services you receive after that point.

One of our insurers, Delta Dental, provides this example. Let's say your individual maximum is $1,000 per year. If you need a crown, the cost could be as high as $1,600. If you pay half, as a major service covered at the 50% level by your plan, you're at $800 toward that yearly maximum. If you already received a cleaning and x-rays that year, add about $150 to your $800 total. That puts you at $950, just shy of your yearly maximum.

#6 Use it or lose it.

Dental insurance costs you money every month. It might not be much money, but over the course of a year, it's still money out of your pocket. Use the services that money can buy. For example, if your individual plan costs $10.95 per month, that's $131.40 per year. That's pretty much the cost of a cleaning and x-ray exam. You might as well go in and get it for free! Don't ignore your dental health, and don't avoid the dentist. Get your money's worth!

Click Here for Dental Insurance Quotes!

Sources:
Oral Health in America: A Report of the Surgeon General, 2000
Delta Dental: Types of Dental Plans


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