Dental Insurance: Here’s All You Need to Know

Dental Insurance: Here’s All You Need to Know

Oct 01, 2020

Your oral health is very important. It has a significant impact on your overall health. For this reason, more and more people are looking for dental insurance policies that can cover the cost of getting that beautiful smile.

Most dental procedures, though affordable, can put a dent in your pocketbook. Thus, finding a dental clinic that accepts insurance can be the difference between a healthy smile and a mouth filled with cavities.

Dental insurance, as compared to medical insurance, is straightforward. You can clearly know which procedures are covered and how much you have to pay out of pocket. However, not all policies are created equal. Therefore, let’s see what dental insurance entails.

Understanding Dental Insurance

In a nutshell, the whole point of getting dental insurance is that it gives you coverage to help you to pay for the services you need. With the dental policies, you can pay part of the fee or nothing at all.

Dental insurance follows a 100-80-50 coverage structure. This means that if you are using a dentist who accepts insurance or an in-network dentist, the dental plans will pay 100 percent of preventive care. These are x-rays, exams, and cleanings.

For basic procedures such as root canals, fillings, and extractions, the plans will pay 80 percent of the fee. If you need major dental work done such as crowns, implants, bridges, and gum disease treatment, the dental plan will only pay 50 percent of the total cost. However, if you are going for cosmetic dentistry or orthodontic treatment, most dental plans will not cover any of the expenses. This is because these procedures are not deemed medically necessary.

  • Insurance plans do the following:

Predetermine the Costs
Some plans will need you or your dentist in Lexington, MA, to submit a proposal to the plan administrator before you receive treatment. This will determine whether you are eligible for the treatment, if you are required to co-pay, and the maximum limitation.

  • Limit Annual Benefits

Your dental insurance will cap the benefits to a number of procedures or amount in a year, to limit the costs.

  • Peer Review for Dispute Resolution

Most plans will have a peer review mechanism that will help resolve issues without going to court. The mechanism is established to ensure fairness.

Factors to Consider When Choosing a Dental Insurance Plan

In reviewing dental insurance plans, consider the following factors:

  • What Does the Plan Cover?

It is essential for you to know what the insurance policy covers so that you can budget for your dental expenses, including expected and emergency costs. There are insurance providers that cover extractions, cleanings, exams, fillings, root canals, gum cleanings, and dentures from the time the policy begins. You will have to wait until the second year to get the benefits for crowns, implants, TMJ treatment, and gum disease treatment. In addition, they will only cover 50 percent of the cost.

If you need major dental work, just bear in mind that you will pay only half the fee. Isn’t that a good deal?

  • Does the Dental Plan Have a Waiting Period?

Dental plans can help you save a lot of money. Preventive care visits are covered within 30 days. You’ll have to wait for up to three months to receive basic restorative services and six months for major restorative services.

For you to reap the benefits of dental insurance, the plan has to remain in effect at least for a year.

  • Is Your Dentist In Your Network?

There are excellent insurance plans that you can go for, including Delta Dental. For example, if you have purchased a plan with Delta Dental, then getting a Delta Dental Premier Insurance dentist will help you save money. You will get to enjoy the full benefits of the plan.

  • Can You Get Group Coverage?

If you get group coverage, most procedures are less expensive than if you purchase individual insurance. If they do not offer group coverage, then check their individual policies. Bear in mind that individual policies may come with limited benefits as compared to group coverage.

Dental insurance is a good way of saving money. However, when you are choosing a plan, choose one that imposes service or dollar limitations, instead of the one that excludes categories of service.

You can contact the dental office near you to find out if they have financing options or accept insurance plans. To find out more, call our dentist near you at Barry J. Cunha.

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