HOW DOES DENTAL INSURANCE WORK?

With the high cost of dental procedures, having dental insurance can go a long way to ease the whole stress. A good dental insurance policy will cover everything from routine exams and cleanings to more difficult procedures like root canals and extractions. So, how does dental insurance work? Read on.

What Is Dental Insurance?

Dental insurance is coverage for dental care. It has traditionally been separate from medical insurance, but companies frequently provide a benefits package that includes both medical and dental insurance.

Dental insurance is frequently offered alongside vision insurance, with both forms of care covered under a single plan. The availability of dental insurance coverage varies by state.

How Does Dental Insurance Work?

How does dental insurance work? You choose a plan based on the providers (dentists) from whom you want to be able to choose and how much you can afford to pay.

If you already have a dentist that you like and who is in the insurance company’s network, you can choose one of the less expensive plans.

If you don’t have a dentist, you can choose from those in the network and, once again, choose a less-priced plan.

You can still receive insurance if your current dentist is not in the network, however, you will pay much more to see your dentist than an in-network dentist—so much more that you may not be able to benefit from insurance.

The monthly premiums you pay will be determined by the insurance carrier, your area, and the plan you select. The monthly charge will be around $50 for many people. This means that even if you don’t get any work done, you’re spending $600 on dental bills each year.

Dental Insurance Waiting Period

Most dental insurance policies have six to twelve-month waiting periods before any routine procedure can be performed. Waiting times for major projects are often longer and might last up to two years. Insurance firms set these periods in place to ensure that they earn from a new account and to dissuade consumers from enrolling in a new policy to cover upcoming procedures.

What Does Dental Insurance Cover?

Dental plan benefits, like other types of health care, vary by plan and insurance carrier. Always review the plan benefits paperwork for the plan you’re considering for further information about coverage. However, in general, a dental insurance policy will cover the following benefits:

Checkups and cleanings on a regular basis, usually twice a year (out-of-pocket copay may be required)

Fillings for cavities
Extraction of teeth
X-rays
Implants, crowns, and bridges
Root canal therapy and other essential repairs
Dental instruments (i.e., retainers)
Oral surgery and other emergency dental procedures

Please keep in mind that certain dental equipment or treatments may be covered, but only to varying degrees. Preventive care, including cleanings, is usually completely covered, however other procedures, such as fillings or emergency oral surgery, may have greater out-of-pocket costs. You may be required to pay a deductible before coverage for certain procedures kicks in. For preventive care, this is frequently waived.

What Will Dental Insurance Not Cover?

While most dental insurance covers basic dental work and preventive care, several procedures are not covered by many. Composite (tooth-colored) fillings are a prominent example of this. Coverage is frequently limited to amalgam (silver) fillings, with policyholders liable for the difference if they prefer composite fillings. Generally, dental insurance will not cover the following:

Orthodontic procedures (braces)
Pre-existing medical condition-related dental treatment
Cosmetic procedure, such as teeth whitening.

Of course, all dental insurance policies differ, so policyholders should review their coverage limits to determine what is and is not covered in their specific circumstances.

Does Health Insurance Cover Dental Care?

As previously stated, dental insurance is often provided in three forms:

In the context of an employer-sponsored health plan
As part of a self-purchased health plan, such as through a broker like eHealth
As a separate dental plan or “rider” (either through your employer or purchased yourself)

Not all health plans include dental benefits, and availability varies by location. Dental benefits are not essential health benefits for people under the healthcare law. This means that if you are over the age of 18, health insurance companies are not compelled to provide dental care.

Please keep in mind that, while insurance companies are not compelled to provide adult dental insurance, dental benefits are seen as a necessary health benefit for children. So, if your health plan covers dependents 18 and under, the plan is required by law to provide dental benefits as part of its health coverage or as a separate dental plan. However, the law only mandates that dental benefits be provided to children; you are not obligated to purchase them.

If your health plan includes dental care, your monthly premium should cover both your health and dental coverage. If you want to add dental coverage as a supplemental benefit, you will pay a separate premium for your dental plan in addition to your health plan premium.

Should You Get Dental Insurance?

If you are currently without dental care, you may be asking whether it is worthwhile to purchase your own policy. There is no uniform answer because everyone’s financial position and oral health requirements are unique. In general, you should begin by comparing the costs of a dental plan to your usual yearly dental care costs. Examine your dentist’s fees for twice-yearly cleanings, X-rays, fillings, and other standard services. Then, compare these prices to the dental plan premiums for various plans. Keep in mind that you may be eligible to deduct your insurance costs when filing your taxes.

When determining whether to purchase your own policy, you should also examine your general oral health. If you have a history of dental problems, it is probably worth the extra money to have the extra piece of mind. Also, if you have Medicare, keep in mind that dental work is not covered unless it is medically required.

Dental Insurance Costs

When looking for insurance that is perfect for you and meets your budget, consider the following factors:

The cost of dental insurance varies. Dental premiums typically run between $20 to $60 per month, although this can vary widely based on your coverage and even where you reside.
Benefits may be covered at various levels of coverage. Preventive treatment, such as routine cleanings, is normally covered completely out of pocket. Following that, some plans may cover 80% of the costs for specified treatments, such as dental fillings, leaving the policyholder with 20% after the annual deductible has been reached. Other insurance may only cover major treatments, such as implants, at 50%, leaving you to pay the other half.
Uncovered operations, such as orthodontics, will be charged in full.
Annual coverage maximums may apply to dental policies. If you exceed your plan’s maximum, you’ll be responsible for any additional dental costs above that level. For example, if your plan has a $2,000 coverage limit, you will be responsible for any remaining costs for the year once your plan has paid $2,000 in dental benefits.
There may be time constraints. Some dental plans only cover particular services, such as fillings or X-rays, once a year or once every few years. As a result, if you require extensive dental work up front, not all benefits may be available right once. If you need the operations right away and can’t wait, you may have to pay out of pocket.

Copays, Deductibles, and Coinsurance

A deductible is an amount that must be paid before the insurance policy will pay anything. For example, if the deductible is $200 and the covered individual’s operation costs $179, the insurance does not cover the difference, and the individual must pay the full amount. At the time of the procedure, copays (specified cash amounts) may also be required.

When a dental deductible is met, most insurance cover only a portion of the remaining expenditures. The patient pays the remaining balance of the bill, which normally varies from 20% to 80% of the entire bill.

The costs and treatments necessary may also fluctuate depending on the patient’s age. Seniors on Medicare, for example, will have a different definition of the greatest dental insurance available than other age groups.

Most dental insurance plans adhere to the 100/80/50 payment structure, which means that they cover 100% of preventative treatment, 80% of basic operations, and 50% of significant procedures.

Dental Insurance Procedure Categorization and Payment

Dental procedures covered by insurance policies are normally classified into three types: preventive, basic, and major. Most dental insurance policies cover 100% of preventive care, such as annual or semiannual cleanings, X-rays, and sealants.

Treatments for gum disease, extractions, fillings, and root canals are the basic operations, with deductibles, copays, and coinsurance determining the patient’s out-of-pocket expenses. Most insurance covers 80% of these treatments, with patients responsible for the remaining 20%. Major procedures, such as crowns, bridges, inlays, and dentures, are often only covered at 50%, with the patient incurring more out-of-pocket costs than minor procedures.

Every policy differs in terms of which procedures are classified as preventive, basic, and major, thus understanding what is covered is critical when comparing policies. Some policies consider root canals to be significant procedures, while others consider them to be simple procedures and cover a much larger portion of the cost.

Patients who may require more expensive procedures should pay close attention to the specifics of their dental insurance policy. A single dental implant, for example, can cost between $3,000 and $6,000. Many basic dental insurance policies exclude implants and those that do have limitations and restrictions. With this in mind, many consumers opt for dental insurance that includes implant coverage.

Does Dental Insurance Cover Cosmetic Procedures?

Cosmetic procedures such as teeth whitening, tooth shaping, veneers, and gum contouring are typically not covered by most dental insurance coverage. Because these surgeries are merely cosmetic in nature, they are not considered medically necessary and must be paid for totally by the patient. Some policies include braces, but they normally require a specific rider and/or delaying braces for an extended period of time.

Maximums for Annual Coverage

Although the majority of medical insurance policies have yearly out-of-pocket maximums, the majority of dental policies have an annual coverage cap. Maximum coverage amounts normally range between $1,000 and $2,000 per year. In general, the larger the monthly premium, the greater the yearly maximum. Patients must pay for 100% of any remaining dental services once they have reached their yearly maximum. Many insurance providers offer policies that allow you to carry over a portion of your unused annual maximum to the following year.

Applying for Dental Insurance Tax Credits

If your medical insurance policy does not include dental coverage, any remaining tax credit that you do not utilize to pay for your family’s health insurance through Healthcare.gov may be allocated to pediatric dental insurance rates. You cannot use tax credits to purchase an extra plan if your health insurance policy includes children’s dental coverage.

Can Tax Credits Work for Dental Insurance?

Both yes and no. If your plan does not offer children’s dental care, you can utilize tax credits to pay for it. You may not use them to purchase an additional plan if the plan includes dental coverage.

How Does Dental Insurance For Braces Work?

If you believe braces are in your future, whether for yourself, your spouse, or your children, you may want to consider dental insurance that covers orthodontia. Some states mandate all licensed dental insurers in the state to cover children’s braces. However, coverage limitations or restrictions may apply. One common example is one that gives coverage for a child’s braces if the braces are required to improve the child’s ability to chew food properly. In this case, teeth straightening to improve a child’s personal appearance is not a covered service.

Similarly, an increasing percentage of individuals seek orthodontic treatment to improve their chewing ability or the aesthetic of their teeth. Unfortunately for people who want to improve their appearance, most dental plans that cover orthodontics for adults exclude cosmetic orthodontic therapy.

Alternatives To Braces

Invisalign is a metal brace alternative. Although this alternative is slightly more expensive than traditional braces, some dental insurance coverage will cover a percentage of the cost.

Even if Invisalign is not officially covered by a dental insurance plan, some insurers will contribute a set amount toward the cost.

In Conclusion,

Many people can efficiently budget for the cost of preserving a beautiful smile thanks to dental insurance packages. Understanding dental insurance policies are much easier than medical insurance policies. Most policies are clear and detailed about which operations are covered and how much you must pay out of pocket. Dental insurance is provided as an add-on to medical insurance policies or as a separate policy.

When shopping for dental insurance, be sure your existing dentist accepts the plan you’re thinking about (unless you’re willing to transfer dentists). Licensed insurance brokers make it simple to look for plans that include your present dentist.

FAQs on How Does Dental Insurance Work?

Can I use my dental insurance immediately?

Most dental insurance policies require a six- to twelve-month waiting period before performing any restorative work. Routine exams and cleanings should be scheduled as soon as possible.

Is there a limit to your dental benefit each year?

Yes, most plans have a benefit cap of $1,000 to $2,000 each year. Patients pay 100% of their dental bills once that limit is reached.

Does dental insurance cover preventive care?

Yes, most dental insurance policies include preventive care, and in many cases, up to 100% of the cost.

References

Healthinsurance.org
Investopedia.com