Three Frequently Asked Questions About Dental Insurance

What a year it has Been Common Causes of Tooth Pain and What You Can Do Before You See Your Dentist

Many companies celebrate the turn of the year by switching insurance policies on you. As 2016 speeds toward its end, let’s take a look at 3 common questions about dental insurance so you know what to expect!

What will dental insurance cover?

It varies from policy to policy, but there are some benefits you can expect to see in most plans, which fall into three categories:

• Preventive: this covers the essentials - cleanings, oral exams, x-rays, fluoride treatments  for children. These are the highest paid services of the plan, often covered in full depending on the provider and the policy.
• Basic: this category will almost always include fillings, one of the most frequently performed dental restorations. Also likely to be in this category are procedures like root canals, periodontal therapy, and fabrication of night guards. You will always owe something for the procedures in this category, usually 20-30% of the total charge.
• Major: crowns, dentures, and implants (if covered) are typically found here. Procedures in this category, given their higher expense, will have restrictions on how often and under what circumstances they can be replaced. You’ll most commonly see 40-60% of the total fee covered here.

In addition to these, the more comprehensive dental policies will often have some orthodontic allowance for children and/or adults that is paid out separately from your annual benefits.

Does it make sense to pay for dental insurance?

That all depends on the insurance options available to you and your general level of oral health. If you have a history of poor health, multiple dental restorations or gum disease, dental insurance will almost certainly save you money in the long run. This is especially true if you have access to a subsidized plan through your employer.

If you don’t have a subsidized option and are in relatively good health, however - needing only your bi-yearly cleanings and the occasional filling - dental insurance might not be for you. At that point you’d want to weigh the cost of these common dental services against your yearly premium to see where you come out on top. Some dental offices, including ours, also offer dental savings plans that give the uninsured a discount on common services.

What type of dental insurance should I choose?

When shopping for self-funded plans or looking over options from an employer, you may be asked to pick between an DHMO and a PPO, the two most common types of dental insurance. There are a couple of key differences between the two:

• DHMO - usually the cheaper of the two plans, a Dental Health Maintenance Organization (DHMO) will limit you to a specific network of contracted dental providers. This is done to control the overall cost of services. However, it can put limitations on the services these providers are able to reasonably offer and will restrict you to a specific set of dentists. This is a good choice if you need something economical.
• PPO - a Preferred Provider Organization (PPO) has both a network of contracted (preferred) providers working at an agreed upon fee, and an “out of network” rate for all other providers. The premiums are usually higher with these plans, but you are free to see the dentist of your choice. While there is a difference between the contracted and out of network rate in some of these plans, it is often negligible. This is the best choice if you want freedom in picking your provider, or if you know that the contracted and out of network rates on your plan are functionally the same.

Our admin team works hard to stay up to date on the ins and outs of our patients’ policies. We’re always happy to answer any questions you may have about your benefits; email or call us today and let us know how we can help!