5 Factors to Help You Get the Most Out of Your Dental Insurance

As dentists, we get it. Everyone wants a beautiful smile, but the fact is dental care can be expensive. Dental insurance helps to ease that cost. Many procedures like preventative care can be completely free, while root canals, crowns, and other dental work that normally cost thousands can be halved. But every policy is different. Are dental implants covered? How much of your root canal are you responsible for? Are veneers covered under your policy? What happens if you have a dental emergency? It all depends on the details of your plan.

Understanding your benefits is key to making the most of them. Your dentist can work with you to ensure you get the best coverage that ensures quality dental care.

Here are 5 things about dental insurance you should know to get the most value for your family.

1. The Different Types of Dental Plans

There are 4 different types of dental plans. Each varies according to quality, cost, and what’s covered.

Dental Preferred Provider Organization (DPPO or PPO): Nearly 82% of all dental plans fall under this category. Under this scenario, a plan covers a network of dentists, and you must choose one in that plan. If you see a family dentist outside that network, costs will be steeper. In-network preventative care is often fully covered or greatly discounted, while other extensive care will cover a percentage of the cost, the amount varying according to each plan.

Like your current family dentist but they’re not in your network? Talk to both your dentist and your insurance carrier. They might be able to work with you, but you’ll likely pay a little more than you would if the dentist was in-network.

Dental Health Maintenance Organization (DHMO of HMO): About 8% of all dental plans are HMOs. Again, you choose from a network of dentists in order to get the full benefit of the plan. In a process known as the capitated payment model, dentists get paid based on the amount of patients in the HMO. Even though you may be required to work in-network, you can still get quality dental care with this plan.

Dental Indemnity Insurance: This tends to be the Rolls Royce of dental insurance plans. At one time, most plans fell under this category but today only 6% do. You can choose any dentist you like and are not limited to a network. Most preventative work is free, but there are deductibles and copays for more extensive work. These plans tend to be more expensive, but they also usually cover more.

Discount Dental Plans: This isn’t technically dental insurance but an ideal choice for those who don’t have dental insurance. Many dentists will offer discounted work packages for enrollees. You pay an annual fee, and your family receives free or discounted work.

2. Preventative Dental Care is Usually Free

The American Dental Association recommends you visit a dentist every 6 months for a checkup and dental cleaning. That’s the idea of having a regular family dentist — you get consistent dental care with regular appointments to keep up on your teeth. This is preventative dental care that tries to nip any problems in the bud and keep your smile in great dental health. Because preventative care can minimize the cost of dental care in the long run, many plans offer it for free or at a highly discounted rate.

3. Restorative Care Can Be Critical

Many dental plans cover 80% of the cost of fillings, extractions, and re-cementing of previous crowns and bridges. This can help your family save substantially on costs. A $400 filling can cost as little as $80. Talk to your dentist about what your plan does and does not cover.

4. Waiting Periods: When Can You See A Dentist?

If you are new to your insurance plan, ask your dentist about any possible waiting periods. Some plans have waiting periods ranging from six to 12 months before any standard work can be done — and even longer for more extensive work. These periods are designed to allow the insurance company to profit off a new patient before committing to high costs. It also discourages patients from signing up to a new plan in the face of impending expensive dental work.

Have a dental emergency and need to see an emergency dentist? Your insurance plan may still cover the work, even if you’re still in the waiting period. Talk to the insurance company and see what they’ll cover.

5. Yearly Maximums

Most dental plans will cap the amount of dental work they cover in a year. This cap can range from $750 to $2,000 per year — typically the higher price of premium, the more a plan covers in a year. Once you’ve reached your limit, you must pay 100% of the cost of further work. This is why it’s important to work with your dentist to create a plan for any work you might need in a year. If you face extensive dental work, try to reach as close as you can to that cap in a given year — before December 31. This is why dentists tend to have their busiest seasons during Christmas.

Forming a To-Do List with Your Dentist

That’s why during your six month dental check up, we like to plan out any work you might need for the year. This is to help you get the maximum benefit of your dental insurance. Most plans don’t roll over. So if you don’t use up all your dental insurance benefits, it won’t extend into the following year. That’s why we encourage you to get all necessary dental work out of the way before the end of the year.

And if we haven’t seen you in the last 6 months, give us a call. Routine checkups and cleanings are most likely fully covered by your dental insurance. Take a proactive approach to your dental care and see a dentist.