Although 77 percent of Americans have dental insurance, how many of us really know how to use it? Knowing the ins-and-outs of your dental insurance plan can help you make the most of your coverage, so it pays to do your research. Read on to learn how dental insurance works, and how to make it work for you.
How Dental Insurance Works
What Is a Dental Insurance Plan?
A dental insurance plan is similar to any other medical insurance plan. In exchange for a monthly premium, a dental insurance plan can cover a portion of your health care costs. Unlike the broader coverage offered by medical insurance, dental insurance specifically covers health care related to your teeth and gums. Most dental insurance plans cover regular procedures as well as preventative care.
The majority of Americans have dental insurance through their employer, which is typically offered as a group plan. Group plans are often the most cost-effective insurance option. They include group rate discounts for services that are negotiated by an intermediary on behalf of all participants. If your employer does not offer dental insurance, you can purchase a private plan from a dental insurance provider.
How Does Dental Insurance Affect My Health Care Costs?
An average dental insurance premium is $50 per month, though this varies by plan and provider. Most dental insurance plans follow the 100/80/50 rule of coverage:
- 100 percent of the costs of preventative care, such as cleanings and exams
- 80 percent of the costs of basic care, like cavity fillings and extractions
- 50 percent of major care, such as root canals
- Cosmetic dentistry, such as whitening or bonding, may or may not be covered depending on your individual plan
In addition to this, there’s typically the cap in the amount of maximum coverage they’ll provide per year. This cap is commonly around $1,500. If you exceed that amount, you will not receive further coverage until the following year. You’ll save money if you keep up with your relatively less expensive preventative care and avoid costly procedures down the line.
How Do You Pick a Dental Insurance Plan?
Whether you’re deciding if you ought to opt-in on a group plan offered through your workplace or shopping for an individual care plan in a health insurance marketplace, it pays to look into the coverage. Check the fine print and see what your out-of-pocket costs will be, as well as what specific procedures are covered and at what level.
A key aspect of how dental insurance works is the differences between types of plans and how they affect your out-of-pocket costs. You’ll want to know to know whether a plan is a Health Managed Organization (HMO) plan or Preferred Care Organization (PPO) plan, and whether your chosen provider is an in-network or out-of-network provider. With an HMO, you will be expected to work with in-network providers only. You will have less choice in who you receive services from, but you may save money. PPOs offer you the opportunity to work with out-of-network providers if there is one you prefer, but possibly at a higher out-of-pocket cost.
In-network providers are providers that have agreed to provide services at pre-negotiated rates. They are typically covered at the time of service via your insurance company. This is often the simplest and most cost-effective option, so if an in-network provider fits your needs, you’re all set! Out-of-network providers have not negotiated rates with your insurance company. Services can be more expensive, and you will often be expected to pay at the time of service. However, if you need expertise for complex procedures or simply prefer to work with a provider that is not in your network, you may decide that it’s worth it. It will ultimately be up to you to find the best plan for your dental health care needs, so do your research!
How Do I Make Dental Insurance Work for Me?
Once you know how dental insurance works, you can use it effectively. Keep an eye on the calendar, and schedule appointments and procedures strategically so you don’t accidentally reach your yearly care maximum before you’ve taken care of all your needed procedures. If you know that you or a family member needs care that is not covered by your plan, such as orthodontics, consider purchasing supplemental insurance. Most importantly, use your preventative care appointments to keep your teeth healthy and avoid paying for other dental work!
Knowing how dental insurance works is the best way to make sure you’re getting the dental care you need. Wilkinson Dental submits to all insurance companies, and will work with you to make sure you’re getting the maximum benefits possible. Ask us how you can make the most of your dental plan! And if you don’t have insurance, explore your financial options.
Looking for a dentist? If you live in or near Springfield, Missouri, contact Wilkinson Dental. Dr. Wilkinson and his team will help you feel comfortable, relaxed, and informed about your oral health. For exceptional and comprehensive dental care, schedule your first appointment today by calling 417-708-0556 or requesting an appointment online. We look forward to hearing from you!