Most people find dental insurance plans confusing, and you're not alone!
When shopping for a dental plan, you'll likely encounter the term "dental benefits" more frequently than "dental insurance." This distinction arises because, although commonly referred to as insurance, dental plans function differently from other healthcare policies. This often leads to confusion and frustration when patients discover that their dental plan does not cover procedures in the same way that their health insurance does for other medical needs.
Here's the key difference: an insurance plan is designed to reimburse you for a loss. For example, car insurance compensates you for the value of your car if it's totaled in an accident, and your health insurance covers the cost of your hospital stay if you're injured in that same accident. In such cases, the insurer bears the risk.
On the other hand, a benefit plan is specifically set up to cover certain costs. Your dental benefit plan may fully cover some procedures and partially cover others. Additionally, you might find that certain procedures recommended by your dentist are not covered at all, highlighting the importance of checking with your plan administrator regarding coverage.
Maximums: This refers to the maximum amount a plan will allocate for dental care within a specified benefit period (usually one calendar year). After reaching this cap, any treatment costs incurred for the remainder of the period will be your responsibility.
Maximums typically range from $500 to $2,000 a year.
Deductible: Similar to auto insurance, a dental plan may include a predefined amount you must pay before benefits take effect.
Most deductibles fall between $25 and $100 per person.
Coinsurance: In fee-for-service benefit plans, coverage involves a predefined percentage of the treatment cost, leaving you responsible for the remaining amount. Coinsurance is the portion you pay after meeting your deductible.
With most plans, preventive services (such as cleanings, X-rays, & exams) are covered at 80-100%, basic services (like restorations/fillings & extractions) at 50-80%, and major services (including crowns, bridges & root canals) at 25-50%.
Exclusions and Limitations: While dental plans can alleviate the financial impact of treatment, they usually don’t cover every dental need. Most plans limit the number of cleanings per year, and some may not cover certain procedures, even if recommended by your dentist. It's crucial to carefully understand any limitations or exclusions before settling on a plan.
Understanding Dental Networks
A dental network consists of dentists contracted with your dental insurance carrier, who agree to provide services at a set fee. A dentist within this network is considered participating or in-network. Fees charged by these dentists often reflect a "discount" or "network savings."
When you see a dentist who is "In-Network" or a participating provider, they agree to accept the insurance fee, even if it's lower than their standard charge, with the difference written off. If you choose a dentist outside the network, you will pay the difference.
Wrapping Up:
While dental insurance can seem complicated at first, knowing these key points can help you make smarter choices about your dental care. One additional tip we have is that you should start with your preferred dentist and ask what insurance they accept and prefer before you buy a plan. The best dental plan in the world won't matter if your dentist doesn't accept that insurance.
- Doug
