Of the 77% of Americans who have dental insurance, most receive their coverage from an employer or group program. When you’re not doing the legwork of shopping around for your own dental insurance plan, you might not understand exactly what your insurance covers until you need to have dental work done––and then find out it’s not covered. That’s why it’s important to understand the ins and outs of your plan before a dental emergency comes up. This is what every patient needs to know about dental insurance.
Understand the Type of Plan You Have
Just like with health insurance, dental insurance plans fall into two categories: PPOs and HMOs. There’s also another type of plan, which isn’t insurance at all, but sometimes gets confused with it: a discount or referral dental plan. Here’s a quick rundown on each option:
- A Preferred Provider Organization (PPO) has a list of in-network dentists where your dental insurance plan can be used. You can go to a dentist who is not in your network, but you’ll have to pay more of the cost out of pocket.
- Dental Health Maintenance Organization (DMHO) plans also have a network of dentists that you can visit for either no fee or a co-pay, but if you choose to see an out-of-network dentist, you will be responsible for the entire cost.
A discount or referral plan simply gives you a discount on services from one specific dentist or a group of participating dental practices.
Know What Your Plan Covers
Some dental insurance plans are better than others. Most cover general dentistry, including preventive care (dental exams and cleanings) and needed restorative procedures, like fillings, crowns, and root canals. Oral surgery is typically covered as well, although it may also be covered by your medical insurance in some cases. Periodontics are usually covered, while orthodontic treatments may be covered in certain circumstances. Dentures are often covered by dental insurance, but dental implants are rarely covered.
Some specialists, like prosthodontists and periodontists, are only covered after a year of coverage; others may be covered, but only if you pay an additional fee.
Know How Much Your Plan Pays
A typical dental insurance plan pays 100 percent of the costs for preventive care. Basic procedures, like cavity fillings, are covered at 80 percent, and major procedures are covered 50 percent.
One area where dental plans can vary greatly is in their annual maximum. Once this number is reached, you are responsible for all of your dental expenses. Even an annual maximum that seems generous can be quickly met if major dental work is needed.
Learn More About Your Dental Insurance Plan
The best way to learn more about your insurance is to consult your provider’s website and contact them, or the Human Resources department at your place of work, with questions. We are also happy to submit pre-treatment estimates to your insurer to help you know how much of your treatment cost you’ll be responsible for. Contact us at 732-739-3070 for our Holmdel location, 732-477-1335 for our Brick location, and 732-531-8533 for our Oakhurst location.