It is no mystery that dental insurance, like most health insurance policies, can be extremely confusing. As you read through information and try to evaluate your options, you will undoubtedly have questions. What does dental insurance typically cover? How do plans differ? Do I really need dental insurance?
In this blog post, you will learn five important dental insurance facts that will assist you in making the most informed decision. The goal here is to gain a better understanding about dental insurance, to allow you to make the best decision for protecting your oral health.
1. How does dental insurance work?
Dental insurance operates similarly to a standard medical insurance plan: you pay a premium for coverage and in turn you have access to benefits outlined in your plan, which your insurance company will provide based on the specific coverage plan you select. Certain dental services (according to your insurance plan), like annual check-ups are always included, but coverage for other treatments will vary. Sounds simple right? Hold off before jumping to any conclusions, because there are many details with the various plans that can impact your decision to purchase dental insurance.
2. What factors to consider?
One thing to consider are waiting periods. Typically, plans won’t cover certain procedures until “a waiting period” is over. For example, a policy may state that for the first six months your insurer will not cover a filling or an expensive treatment. Insurance companies do this to prevent people from signing up with their insurance plan, going through an expensive procedure, and then trying to leave the insurance policy immediately after the treatment is done.
You will find, every dental insurance plan is a little different and each one has many factors to review and understand
3. What is typically covered with dental insurance?
A very important factor in choosing dental insurance is knowing what services the plan will cover. In most cases, dental insurance will provide coverage for preventive and diagnostic procedures. For example, if you get a cavity or need a basic procedure such as a filling, your insurance may cover most of the procedure. However, if you are needing more intensive and complicated procedures, your coverage will more than likely be less and require a waiting period.
The following procedures are broken down to provide an example of high coverage to low coverage of services under most plans:
- Most often covered (diagnostic/preventive procedures): teeth cleaning(s), oral exams, oral x-rays, check-ups, etc.
- Partially covered (basic procedures): fillings, root canals, etc.
- Not always covered (major procedures): dentures, crowns, bridges, etc.
4. What options do I have for dental insurance?
To understand dental insurance options, you will need to understand the three varieties of insurance you can choose from:
- Health Maintenance Organization: HMO is a health insurance that will restrict your coverage for care (whether medical or dental) from medical professionals outside their contracted network. Often times this network is limited, so it may not include one of the specialists or professionals you want to see. Before choosing this insurance method, make sure to ask who and what is in their network.
- Preferred Provider Organization: PPO is similar to the health maintenance organization insurance plan, except you are given more freedom to see professionals outside of their preferred network. Although they offer more freedom to see individuals outside the network, you still may have to pay an additional cost. However, some insurers do offer the incentive of reduced rates if they see an in-network dentist instead of an out-of-network professional.
- Indemnity: Also known as “fee-for-service” plans, allow an individual to see any dentist and will not force you to stay in the network. However, similarly to PPO, when you visit an in-network dentist, you will pay coinsurance (certain percentage of each service) and then your dental insurance will pay the rest. The percentage you are covered by your dental insurance depends on the type of procedure or service you are receiving. Shown in the What is typically covered with dental insurance? part of this blog, you can estimate how much you would have to pay out of pocket and how much your insurance will absorb.
- Out-of-pocket: This last option, although not an insurance plan, can sometimes be preferred depending on the individual’s wants and needs. Many dental practices and professionals have in-office specials where discounts are given, typically when signing up for a yearly membership. These yearly memberships usually outline what they will provide for the yearly price, and what discounts they offer by having that membership. Here at Artistic Dental, we offer an AristicD Cares Plan, where membership on a yearly basis provides coverage to many basic procedures and discounts on more advanced procedures.
5. Should I purchase dental insurance?
Deciding if you want to sign up for dental insurance plan, even with the detailed information we’ve provided can be tricky. Below is a list of pros and cons to help gage whether or not you want to sign up for dental insurance:
PROS:
- If your existing dentist is already in your insurance’s network, you will not have to pay more visit your dentist.
- If you are in need of major procedures in addition to preventive care, you may want to opt for an insurance plan. Paying for preventive care, basic treatments, and major procedures could leave you with a very large dental bill.
CONS:
- If you have a dentist that isn’t in your insurance’s plan network, you may have to pay more to continue seeing them (which can be costly).
- If your teeth and gums are healthy and you only need preventive care, you are likely to lose money paying for dental insurance. Paying directly for preventative care instead of paying monthly premiums, can save you money.
- Waiting periods can prevent coverage for procedures you need at a particular point in time.
Information on dental insurance is complex, especially when comparing the options between dental plans. At Artistic Dental we can help you whether you are insured or not, thanks to alternatives like our ArtisticD Cares Plan, CreditCare and other payment options.