Approximately 77 million Americans have dental benefits with most having private coverage through an employer or group program. Since dental insurance doesn’t work the same way as a typical medical insurance plan, it isn’t always the easiest thing to navigate. To fully maximize your coverage, it pays to know a little bit about your plan. Read on to learn about the most common types of insurance plans and what you can expect yours to include.
What Types of Dental Insurance Plans Are Out There?
There are a few different types of dental plans out there. Here are the two most common ones:
- Dental Health Maintenance Organization (DHMO): With this insurance plan, your insurance provider will give you a list of dentists that will accept your plan for a set co-pay or no fee. However, you won’t receive any coverage if you see a dentist that’s not on this list of in-network dentists.
- Preferred Provider Organization (PPO): A PPO plan gives you the option to choose whatever dental provider that you like. You will still have a list of dentists who are in-network with your insurance plan, but you can choose one that is out-of-network as well. However, if you do this, you are more likely to end up with higher out-of-pocket costs.
What Does Your Dental Insurance Plan Cover?
The most common dental insurance plan follows a 100-80-50 coverage structure. Typically, this means that they will cover the following dental treatments and procedures:
- 100% of Preventive Care: This includes regular cleanings, checkups, routine X-rays, and more.
- 80% of Basic Procedures: Basic procedures are fillings, gum disease treatment, and other non-invasive procedures.
- 50% of Major Procedures: Things like root canal therapy, dental implants, crowns, and orthodontic treatment often fall into this category.
5 Dental Insurance Terms You Should Know
Here are some terms that will come up often as you’re learning more about your dental insurance plan:
- Coinsurance: If you have a fee-for-service plan, this will pay a predetermined percentage of the cost of your treatment and leave you responsible for paying the remaining amount. This part of your out-of-pocket cost is known as “coinsurance.”
- Copayment: If you have a closed network, prepaid, fixed copayment plan, you will pay a set dollar amount for covered services instead of a percentage.
- Deductible: This is the amount that you pay every year out-of-pocket before your insurance begins to cover treatment costs. This doesn’t usually apply to diagnostic and preventive treatments.
- Maximum: This is the most money that your plan will cover within one benefit period. The remaining costs will be left to you.
Now that the year is coming to an end, your unused benefits will not carry over to 2023. If you need dental treatment, or it’s been a while since your last checkup, there’s no better time to schedule an appointment. This way, you won’t need to worry about your deductible until later on. Use your benefits before it’s too late!
About the Author
Dr. Shayan Azimi earned his dental doctorate from Nova Southeastern University. He has taken a lot of continuing education focused on dental implant dentistry, including courses through Live Dental Implant Training and the International Congress of Oral Implantologists. He’s also a proud member of the American Dental Association and the Academy of General Dentistry. For more information on dental insurance or to schedule an appointment at his office in Dallas, visit his website or call (469) 981-1700.