Your mouth is important. It’s nice to have a beautiful smile, but dentistry goes beyond appearance. Dentistry is about taking good care of your teeth and preserving your ability to eat regular food. Your ability to eat affects your nutrition, which is a cornerstone of maintaining your overall health. An unhealthy mouth can also lead to other health challenges like heart disease.
Dental insurance works like health insurance because it helps pay for the care your gums and teeth need. Luckily, dental insurance isn’t as complex as health insurance. Here are the most important things you need to know about dental insurance before you buy it.
Annual Maximum Benefit: The most your dental plan will pay towards your dental care for the year. If the cost of your care exceeds this amount, you’ll be responsible for paying the excess.
Basic Services: Simple dental procedures like fillings that help maintain tooth function.
Deductible: The amount you pay out-of-pocket before the insurer takes more responsibility.
Diagnostic Services: Dental procedures to diagnose illnesses and inform your treatment plan.
In-network: Care you receive from dentists who accept your insurance plan. These dentists accept your insurance’s pre-negotiated rates.
Limitations and Exclusions: Services not covered by the plan or circumstances in which the plan won’t cover certain dental treatments.
Major Services: More intense dental procedures like crowns and bridges
Out-of-network: Care you receive from dentists who are not contracted with your insurance company. If your plan offers out-of-network coverage, you’ll still receive some help paying the costs of your care.
Premium: Monthly fee for participating in a dental plan.
Preventive Services: Dental treatment to prevent decay. These typically include cleanings, x-rays, and sealants. Most plans offer good coverage for preventive care.
There are several kinds of dental plans. The two categories are network plans and indemnity plans.
Network plans have set provider networks. Some plans like Dental Health Maintenance Organization (DHMO) plans only offer in-network coverage. With these plans, you must see an in-network dentist for your plan to help pay the costs. However, you may be able to find a DHMO plan with a Point of Service (POS) option that offers minimal out-of-network coverage.
Other plans like Preferred Provider Organization (PPO) plans offer both in- and out-of-network coverage. Coverage rates tend to be higher for in-network dentists and lower for out-of-network dentists. While these plans offer nice flexibility when choosing a dentist, you’ll get the most value from your plan by seeing an in-network dentist.
Indemnity plans are also called Fee-For-Service (FFS) plans. These plans have set benefit fees for each dental service. You only pay for the services you receive and usually submit claims yourself. You’ll typically have lower monthly premiums, but higher out-of-pocket fees.
There are several kinds of specialties within dentistry, so there is more than one kind of dentist. Here’s a list of the types of dentists you may work with as you take charge of your oral health.
General dentists are your main point of contact. They perform exams following cleanings and focus on preventive care and diagnosis. General dentists also handle many restorative treatments, like fillings.
Pediatric dentists focus on children’s dentistry.
Periodontists specialize in gum disease and treating gum tissue. They can do implants and gum grafts. If you have cancer in your gums or other gum diseases, you may be referred to a periodontist by your dentist.
Endodontists work on the tooth’s interior pulp and nerve. They perform root canals to stop pain with preserving patients’ original teeth. While some general dentists also perform root canals, you may need to see an endodontist if you’re experiencing pain inside your tooth.
Prosthodontists specialize in prosthetics. They help with crowns, bridges, dentures, implants, and veneers. They also work on crowns, bridges, dentures, implants, veneers; cosmetic and traumatic reconstruction. All your prosthetic dental needs can be taken care of by a prosthodontist.
Orthodontists help people maintain their teeth by making sure that they align properly. If you don’t need prosthetics, an orthodontist can help ensure that your teeth and bite are aligned properly.
Oral and maxillofacial surgeons perform surgeries including extractions, jaw surgery, cleft lip, and cleft palate surgery. When you get your wisdom teeth removed, you’ll probably see an oral surgeon.
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Dental insurance premiums vary based on the plan you choose and the number of people on your plan. Premiums are also affected by the demographics (e.g. age) of the people on the plan. Typically, the younger you are, the cheaper it is.
Your insurance plan needs to include coverage for dental implants. Keep in mind that some plans have restrictions on implant coverage depending on how long you’ve had the plan or if you were already missing the tooth before you bought the plan.
Read “What You Need to Know About Dental Implants and Dental Insurance” to learn more about your options.
In some cases, you may be able to purchase dental insurance through your employer. This is convenient because group rates tend to be cheaper than purchasing a private dental plan.
You can also buy dental insurance privately. You’ll either work directly with the company or an insurance agent to find a plan that meets your needs and enroll.
With most dental insurance plans, your dentist will file a claim with the insurance company. Once the insurance company has paid its portion, you’ll be billed for your portion.
If you have an indemnity plan, you pay the full discounted price. The insurance company has negotiated discounted rates with its network providers, so that’s what you’ll pay out-of-pocket for the dental care you receive.
Coverage varies by plan. However, most plans offer coverage for preventive treatment. It’s also common to have basic restorative (e.g. fillings) and major restorative (e.g. root canals) covered, too. Read your plan’s limitations and exclusions to have a better understanding of what isn’t covered.
Some plans include coverage for orthodontia. Most commonly, the coverage is for children, but you can find plans that offer orthodontic coverage for adults.
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