Anyone who has ever had a cavity filled understands the importance to dental care, and anyone who has had to pay the dentist’s bill also understands that good dental insurance is a key factor in maintaining good oral health. Tooth injuries, and even routine cleanings can be incredibly expensive when you don’t have insurance to rely on, and if you have teenagers who need orthodontics, you know insurance is a financial lifesaver.
While many people are lucky enough to have corporate insurance plans that include dental coverage, many people do not have that option. When shopping for private dental insurance, then, there are a few things you should know.
Typical Dental Insurance
While policy details will differ from company to company, and individual to individual, the typical dental insurance plan has three basic categories of coverage. These are:
- Diagnostic and Preventative Care: This includes annual checkups, and other standard procedures, such as semi-annual cleanings, that help prevent tooth and gum disease, reducing the necessity for major treatments, like root canals, and offering early detection of potential problems. This may be the most important facet of dental insurance.
- Basic Care and Procedures: Basic dental care includes minor treatments like filling cavities, extracting teeth that cannot be repaired, and fixing chips. Some providers also include root canals in their basic care clauses, but others do not, so if you have a family history of bad teeth, pay special attention to this category.
- Major Procedures: Major dental care, which includes root canals, orthodontics, and denture work, as well as dental surgery such as removal of wisdom teeth, is not covered by all policies, so shop wisely if you anticipate needing any of these procedures.
While most insurance plans cover all three of these categories of dental care, there are also many factors that may limit the benefits you actually receive, and how much of your dental bill is covered by insurance. These factors include:
- Network requirements: If your dental insurance plan uses a “network” of doctors, you may not get the same level of coverage if you choose a dentist who is not “in-network.” This is very similar to choosing a primary care physician who is not part of your preferred-provider organization.
- Deductibles: You may be required to pay a portion of your dental bill up front, before insurance kicks in. Some dentists will bill insurance first, and then bill you for the balance, but this varies from dentist to dentist, as well as plan to plan.
- Maximum Amounts: Most dental insurance plans give you an annual maximum dollar amount of coverage, and anything over that amount falls to you to pay out of pocket. These maximum amounts do not roll over, so if you spend less than your maximum one year, the balance is simply gone.
As with all insurance, dental plans vary widely between insurance companies. Be sure to do careful comparison of exactly what is covered, and what other restrictions might be in force.