When considering dental insurance, you must make many decisions, and ultimately, it becomes a confusing, tangled journey.
Therefore, we intend to help clarify some typical dental insurance questions.
What is Dental Insurance?
Dental insurance is a personal insurance plan provides coverage for dental care which requires monthly premiums for covered dental services.
Also, the applicant may be required to pay some deductible or copay for dental services.
There are three primary categories of dental insurance coverage:
- Orthodontic
- Restorative
- Preventative
What Can Dental Insurance Cover?
Most dental insurance begins with a list of excluded and included procedures.
Typical Inclusions:
- Simple extractions
- Teeth cleaning
- Crowns
- Root canals
Typical Exclusions:
- Braces
- Veneers
- Implants
- Dentures
- Aligners
Orthodontics Coverage Option
It is essential to ask and understand the depth of coverage with an insurance policy.
For example, some policies may or may not provide orthodontics, so make sure to ask and know if orthodontics coverage is part of the policy.
Usually, orthodontics coverage commands much higher rates.
What Does Dental Insurance Not Cover?
Dental insurance typically does not cover any dental procedures requiring aesthetic dentistry or cosmetic procedures.
Dental insurance does not cover cosmetic dentistry because it does not qualify as “medically necessary.” Aesthetic dentistry includes such procedures as veneer procedures or teeth whitening.
The determining factor is the procedures focus on improving a patient’s appearance but not resolving damaged teeth.
Cosmetic dental procedures are most popular for the 31-40 age group (38 percent of the group) and the next for the 41-50 age group (32 percent).
Are There Any Dental Insurance Policy Limits?
Yes, and the limits typically are between $1,000-$2,000 per benefit period, typically at the beginning of the year.
Each dental claim has an amount the insurance provider has to pay. The amount on the dental claim the insurance provider had to pay deducts from the policy maximum.
Once reaching the maximum, the policyholder becomes responsible for 100% of the dental claim until the policy anniversary date.
Key points to consider when evaluating the annual dental maximum.
- Copays do not apply to the annual maximum
- The insurance policy deductible does not apply to the annual maximum
- Additional costs for a dental claim beyond the copay and the deductibles apply to the annual maximum.
- It is not uncommon for some dental insurance carriers to apply the coinsurance percentage to your annual maximum.
If you have questions, we’re always here to help. Of course, your dental office may also be able to help suggest some possible solutions—especially if they work with a certain insurance carrier or provider.
Speak with your dentist administrator and ask about a long-term treatment plan which meets your dental needs, and we’ll help you match a policy which should mitigate some costs down the road.