Did you know that about 77 million Americans have dental benefits? Most have private coverage through an employer or group program. Since dental insurance doesn’t work the same way as a typical medical insurance plan, it isn’t always the easiest thing to navigate. In order to fully maximize your coverage, it pays to know a few things about your plan. Continue reading to learn about the most common types of dental insurance plans and what you can expect yours to cover.
What Are the Different Types of Dental Insurance Plans?
There are a few different types of dental plans out there. Here are the most common ones available:
- Dental Health Maintenance Organization (DHMO): With this insurance plan, your insurance provider will give you a list of dentists that will accept your plan for a set co-pay or no fee. However, you won’t receive any coverage if you see a dentist that’s not on this list of in-network dentists.
- Preferred Provider Organization (PPO): A PPO plan gives you the option to choose whatever dental provider that you like. You will still have a list of dentists who are in-network with your insurance plan, but you can choose one that is out-of-network as well. However, if you do this, you are more likely to end up with higher out-of-pocket costs.
- Discount Dental Plan: This plan allows you to get discounts on dental services from a select group of dentists. None of your care is necessarily covered, but participating dentists will give you a discount on your care.
What Does Your Dental Insurance Plan Cover?
The most common dental insurance plans follow a 100-80-50 coverage structure. Typically, this means that they will cover the following dental treatments and procedures:
- 100% of Preventive Care: This includes regular cleanings, checkups, routine x-rays, and more.
- 80% of Basic Procedures: Basic procedures are fillings, periodontal scaling, and other non-invasive procedures.
- 50% of Major Procedures: Things like root canals, dental implants, crowns, and orthodontic treatment often fall into this category.
5 Common Insurance Terms You Should Know
- Coinsurance: If you have a fee-for-service plan, this will pay a predetermined percentage of the cost of your treatments and leave you responsible for paying the remaining amount. This part of your out-of-pocket cost is known as “coinsurance.”
- Copayment: If you have a closed network, prepaid, fixed copayment plan, you will pay a set dollar amount for covered services instead of a percentage.
- Deductible: This is amount that you pay every year out-of-pocket before your insurance begins to cover treatment costs. This doesn’t usually apply to diagnostic and preventive treatments.
- Dual Coverage: For patients who have benefits from multiple plans, this is called “dual coverage.” However, the total amount paid cannot exceed 100% of dental expenses.
- Maximum: This is the most money that your plan will cover within one benefit period. The remaining costs will be left to you.
The year is coming to an end, and your unused benefits will not carry over to 2022. If you are in need of dental treatment or it’s been a while since your last checkup, there’s no better time to head to the practice. This way, you won’t need to worry about your deductible until later on. Use your benefits before you lose them!
About the Author
Dr. Eric L. Tolliver earned his Doctor of Dental Surgery degree from the University of Missouri – Kansas City before being accepted into a residence program for Advanced Education in General Dentistry. This program featured comprehensive training in cosmetic smile design, advanced fixed and removable prosthetic restorations, and implant dentistry. Currently, he is a proud member of several professional organizations, including the American Dental Association and Missouri Dental Association. For more information on your dental insurance benefits or to schedule an appointment at his office in Springfield, visit his website or call (417) 887-5757.