Dental Insurance Facts: What You Need to Know

Dental insurance is a great way to help pay for the high cost of dental care. The average cost of a dental filling or crown ranges between $300 and $1,000. The expense can be overwhelming if you don't have coverage. However, getting dental insurance isn't as simple as it seems. There are many different plans, some more beneficial than others. There are also pros and cons to consider before purchasing an insurance plan.

Consider these dental insurance facts before you decide.

Pays More for Some Treatments and Less for Others

Most insurance plans offer what is called tiered coverage. These tiers are often 100/80/50. What this means is that different treatments are covered at different percentages. Preventive treatments, such as cleanings and checkups, are often covered at 100%, which means you won't pay for those treatments.

Simple treatments, such as routine fillings or extractions, are covered at 80%, with you paying 20% of the treatment cost. Major treatments, such as root canals, crowns, dentures, or bridges are covered at 50%. In some cases, major treatments are covered at less than 50% or not at all. It is important to consider your family's oral health history and what kind of treatments you expect to need to choose a plan that will benefit you and your family the most.

Compare Dental Insurance Coverage and Dentist Costs

This goes along with the fact that insurance plans offer tiered coverage. Dentists set their own prices for treatments. This means that even with the same insurance plan, you may pay more out of pocket with one dentist than another. When choosing a plan, you should call some of the participating dentists and ask about the cost of different treatments. Compare the costs of each pediatric dentist in your area with the others that accept the same insurance as well as with the insurance plan itself.

Braces Aren't Always Covered

If you get dental insurance through an employer, there is often an allowance for braces. Not every plan will cover braces, however. Those that do may only cover them for children or for certain conditions or up to a certain age . Additionally, it may only be partial coverage. This means that the plan might cover the cost of the initial exam and installing the braces.

 However, you may be responsible for all follow-up costs. These include additional cleanings, tightenings, additional tooth extractions that may be needed, and/or retainers. You'll want to make sure you know what is and is not covered before choosing a plan or moving forward with braces so you aren't surprised by unexpected expenses.

DHMOs Are Cheaper, But PPOs Offer More Provider Choices

DHMOs (Detnal Health Maintenance Organization) and PPOs (Preferred Provider Organization) are two different options for dental insurance coverage. They are cheaper insurance plans with restrictions on which dentist you can use and sometimes which treatments are covered. PPOs are more expensive but usually offer a wider network of providers, more treatment coverage, and allow out-of-network treatment at lower costs.

 DHMOs have a lower premium and if your teeth and mouth are generally healthy, may provide all the coverage you need. But if you have a lot of dental issues, or anticipate major treatments such as braces, crowns, or root canals, you may want to spring for the extra expense of the PPO so you have more options.

Some Dental Insurance Plans Have Waiting Periods

You'll want to check with the insurance company to determine whether there's a waiting period , especially if you're seeking coverage for a specific need. Some insurance companies have waiting periods just for major treatments while others may have a waiting period before covering any treatment, including cleanings.

Coverage Doesn't Roll Over

You get certain benefits from your insurance plan each year, such as two cleanings and two checkups. These benefits do not roll over from one year to the next, which means if you don't use them, you've spent money on the plan's premium and gotten little to no benefit from it. Instead of letting benefits disappear unused, take advantage of them.

 Find out what benefits your plan offers annually, such as cleanings, X-rays, or checkups, and schedule appointments to use them. If your plan gives you two cleanings per year, schedule two appointments about six months apart. It's also important to confirm whether those annual benefits are per calendar year (which is standard) or based on when you purchased the plan.

Other Costs to Consider

There are other costs to consider when getting dental insurance. For example, when getting dental insurance, keep in mind that dental X-rays may not be covered. Many insurance plans will cover the cost of X-rays only if they are deemed necessary. Be sure that you communicate with your dentist about whether X-rays are necessary before the procedure.

Go in Knowing There's More to Learn

Getting dental insurance is a smart choice for many people. Sometimes, a dental savings plan or a health share account, or health savings account (HSA) may make more sense. Therefore, it's important to look for insurance knowing there's more for you to understand than what you see on the surface. Go beyond the monthly premium and deductible and dig into the fine print to make sure you get the right plan for you and your family.

Sweet Tooth Pediatric Dentistry and Orthodontics accepts all major insurance providers. Call us today to set up your appointment!