Approximately 77 million Americans throughout the country have dental benefits, with most having private coverage through an employer or group program. However, dental insurance doesn’t work the same way as the medical insurance that you’re used to, so it can be confusing to navigate. Read on to learn about the different popular plans that are out there, what they cover, and some terms that will be useful for you.
What Types of Dental Insurance Plans Are Available?
There are a few different plans out there to pick from. Here are some of the more common:
- Dental Health Maintenance Organization (DHMO): With this type of insurance plan, your insurance company gives you a list of dentists that will accept your plan for a set co-pay or no fee. However, you won’t receive any coverage if you see a dentist that’s not on this list of in-network dentists.
- Preferred Provider Organization (PPO): A PPO plan gives you the option to choose whatever dental provider that you like. You will still have a list of dentists who are in-network with your insurance plan, but you can choose one that is out-of-network as well. However, if you do this, you are more likely to end up with higher out-of-pocket costs.
- Discount Dental Plan: This plan allows you to get discounts on dental services from a select group of dentists. None of your care is covered, but participating dentists will give you a discount.
What Do Dental Insurance Benefits Cover?
The majority of dental insurance plans follow a 100-80-50 coverage structure. This means that they will cover the following treatments and procedures:
- 100% of Preventive Care: This includes regular cleanings, checkups, routine x-rays, and more.
- 80% of Basic Procedures: Basic procedures are fillings, periodontal scaling, and other non-invasive procedures.
- 50% of Major Procedures: Things like root canals, dental implants, crowns, and orthodontic treatment often fall into this category.
Common Dental Insurance Terms You Should Know
- Deductible: This is amount that you pay every year out-of-pocket before your insurance begins to cover treatment costs. This doesn’t usually apply to diagnostic and preventive treatments.
- Copayment: If you have a closed network, prepaid, fixed copayment plan, you will pay a set dollar amount for covered services instead of a percentage.
- Coinsurance: If you have a fee-for-service plan, this will pay a predetermined percentage of the cost of your treatments and leave you responsible for paying the remaining amount. This part of your out-of-pocket cost is known as “coinsurance.”
- Dual Coverage: For patients who have benefits from multiple plans, this is called “dual coverage.” However, the total amount paid cannot exceed 100% of dental expenses.
- Maximum: This is the most money that your plan will cover within one benefit period. The remaining costs will be left to you.
Now that the year is coming to an end, you will miss out on any unused benefits if you don’t use them, as they will not carry over to 2022. If you are in need of dental treatment, now is an excellent time to schedule an appointment. This way, you won’t need to worry about your deductible again quite yet. Utilize your benefits before it’s too late!
About the Author
Dr. Lisa Wadsworth is an experienced dentist who has been working in the field for over 25 years! She earned her Doctor of Dental Medicine from the University of Florida and is a proud member of several professional organizations, including the American Dental Association, Florida Dental Association, and International Team for Implantology Study Club. For more information on your dental insurance benefits or to schedule an appointment at her office in Lady Lake, visit her website or call (352) 750-0008.