What do dental insurance plans cover?

Dental insurance is a type of insurance specifically designed to cover procedures and services related to your teeth. Dental insurance is usually purchased separately from your regular health insurance, which often does not cover dental services.

How Does Dental Insurance Work?

Dental insurance covers a portion or the cost of covered treatments and procedures related to the care of your teeth and gums. You will pay a monthly premium to your insurance company, and in return, your insurance company agrees to pay for covered dental care costs up to a certain amount. Similar to health insurance, there is likely to be a deductible as well as coinsurance and cost-sharing associated with your dental insurance plan.

Key Dental Insurance Terms

Key dental insurance terms include:

• Annual Maximum: This is the maximum amount your dental insurance plan will pay for services each year. For example, if your annual maximum is $1,000, your plan will pay up to $1,000 of covered service costs after the deductible.
• Coinsurance: This is the percentage of the procedure cost that you are expected to pay. Your plan may pay 80% of the cost of a specific service, meaning you are responsible for covering the remaining 20%.
• Copayment: This is the fixed amount you will pay for a specific service after meeting your deductible. For example, your plan may require you to pay a $20 copayment for a dental office visit.
• Covered Services: These are the list of procedures, tests, and services that your dental insurance plan covers.
• Deductible: This is the amount you will pay out of pocket for dental services before your insurance kicks in. Preventive care such as teeth cleanings may be covered even if you haven’t met your deductible.
• Waiting Period: You may have to wait a certain period after enrolling in a dental insurance plan before you can use certain specific benefits, known as the waiting period.
• Out-of-Pocket Maximum: This is the maximum amount you can spend on covered services under your plan. If you reach the out-of-pocket maximum, your plan will cover 100% of the cost of covered services for the remainder of the year.

Types of Dental Insurance Plans

The most common types of dental insurance include:

• Dental Indemnity Plans: Also known as fee-for-service plans, these are dental insurances that are not tied to a network. Typically, there are no restrictions on the dentists you can visit. Your plan pays for covered dental care (after the deductible) at a percentage of the service cost. The specific coverage amount is determined by your plan. Indemnity plans may have deductibles, waiting periods, and annual coverage limits.
• Preferred Provider Organization (PPO) Plans: These use a network of dentists who contract with your insurance company to provide dental services at reduced rates. Dentists are paid on a fee-for-service basis by your insurance company after each visit. PPO dental plans typically have waiting periods before covering services.
• Dental Health Maintenance Organizations (DHMO): These use a network of dentists to provide care. Your insurance company pays each dentist in the network a set monthly fee. When you visit a network dentist, you usually have to pay a copayment for care. Unlike PPO dental plans, DHMOs typically do not have annual coverage limits or waiting periods.
• Dental Discount Plans: Dental discount plans or dental savings plans provide financial savings on your dental visits but are not insurance plans at all. A third-party company offers a dental discount plan in collaboration with a network of dentists. Partner dentists agree to lower their prices for plan members. These plans may even include cosmetic procedures. Since dental discount plans are not insurance, there are no waiting periods or coverage limits.

Coverage

For Different Types of Services

The benefits of dental insurance cover specific treatments and services. Your plan will determine which dental services are covered and the amount your insurance company will pay for each service. Covered services are typically divided into three categories:

• Preventive Care: Preventive care services are designed to help prevent oral health problems. Most dental insurance plans provide the highest level of coverage for preventive services because maintaining healthy gums and teeth reduces the risk of needing more expensive procedures in the future. Common types of preventive care include: semi-annual checkups, routine cleanings, X-rays, fluoride treatments, and sealants. Preventive treatments are often fully covered by dental insurance with no deductible, meaning there is typically no cost to you for preventive services.
• Basic Services: Basic coverage helps pay for routine non-preventive dental care, such as fillings, tooth extractions, and root canals. Many dental insurance providers design plans to cover 80% of basic dental care. You will also need to cover your deductible and any amount exceeding the annual maximum when receiving basic care.
• Major Procedures: Depending on your dental insurance plan, you may have coverage for major procedures. You can expect to pay a higher percentage of the costs for these services or share in the costs. Major dental procedures typically include: crowns, dentures, implants, and oral surgery. Many plans cover 50% of the costs of major procedures. However, you may have to wait a certain period before you can undergo a major procedure.

What is Not Covered?

The specific services that are covered or not covered vary by dental insurance plan. For example, a plan may choose to cover only preventive care and not cover major procedures. However, most dental insurance plans do not cover cosmetic services, such as teeth whitening or veneers, and orthodontic treatments are often not covered either.

Frequently Asked Questions (FAQs)

Here are some common questions about dental insurance:

• Is there a deductible in dental insurance? Yes, most dental insurance plans require you to pay a certain amount out of pocket for some covered services. However, many plans may not require a deductible for preventive or diagnostic care, such as routine cleanings.
• Will dental insurance cover treatment recommended by my dentist? Dental insurance plans cover a specific set of procedures based on the individual plan. To avoid paying out of pocket for a recommended treatment, first talk to your dental insurance plan administrator to ensure the procedure is covered.
• Can I purchase dental insurance on the health insurance marketplace? Yes, the health insurance marketplace has separate dental insurance plans and health insurance plans that include dental coverage. However, you can only purchase dental insurance on the marketplace if you are also purchasing a health insurance plan.

Sources:

• Healthcare.gov. “Dental Coverage in the Marketplace.”
• National Association of Dental Plans. “Glossary of Dental Insurance and Dental Care Terms.”
• Delta Dental. “What Does My Dental Insurance Cover?”
• United Health Care. “Dental insurance Plans.”

Source: https://www.thebalancemoney.com/what-does-dental-insurance-cover-5200169