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What Is Dental Insurance?
Dental insurance is insurance that covers dental health and care. Because dental health, also called oral health, is important to your overall health, you may want to get dental insurance to help you pay for the cost of your dental care. You can purchase dental insurance as part of a medical insurance health plan or as a separate policy through a dental insurer, the Health Insurance Marketplace, or a private insurance broker.
Dental Insurance vs. Dental Benefits
An insurance plan is meant to absorb risk (for instance, the risk that you’ll need to have a tooth pulled, or to get a root canal ), and it covers costs accordingly.
A benefits plan covers some things in full, but other things only partially, and others not at all. It’s meant to be helpful, but it’s not a catch-all.
If you have dental benefits, do you know what’s in the fine print and what type of plan is best for you?
Many Americans (79%) have dental benefits, the National Association of Dental Plans (NADP) says. Most people have private coverage, usually from an employer or group program. Large employers are more likely to offer dental benefits than small employers, and high-wage workers are more likely to receive them than low-wage workers. Medicare doesn’t cover dental care, and most state Medicaid programs cover dental care only for children.
To make the most of your benefits, you need to know these things. When you shop for dental coverage, make sure you understand what type of plan you are choosing, and what it covers.
Preventive Care Pays Off: Exploring the Importance of Routine Check-ups and Cleanings
Preventive Care Benefits Routine check-ups, cleanings, and preventive treatments are fundamental elements of dental insurance coverage. These services help maintain oral health, prevent dental problems,
Beyond Basic Cleanings: Uncovering Coverage for Specialized Dental Services
Coverage for Specialized Services Dental insurance can extend beyond basic cleanings and fillings to cover a variety of specialized services, including: Dental Implants: Used for
Maximizing Your Coverage: Exploring Annual Maximums and Benefits Renewals
Understanding Annual Maximums Most dental insurance plans have an annual maximum, which is the total amount the insurance company will pay for covered services in
Unlocking Dental Benefits: Understanding Waiting Periods and Exclusions
Waiting Periods Explained When you enroll in a dental insurance plan, you might encounter waiting periods before certain benefits become available. These waiting periods can
Beyond Basic Cleanings: Coverage for Specialized Dental Services
Coverage for Specialized Services Dental insurance can extend beyond basic cleanings and fillings to cover a variety of specialized services, including: Dental Implants: Used for
Dental Insurance Categories
Although the features of plans may differ, the most common dental insurance offerings can be grouped into the following categories:
Direct reimbursement programs
Direct reimbursement programs pay you a predetermined percentage of the total amount you spend on dental care, regardless of the treatment category. This method typically doesn’t exclude coverage based on the type of treatment needed and allows you to go to the dentist of your choice. And it encourages you to work with your dentist toward healthy and economically sound solutions.
“Usual, customary, and reasonable” (UCR) programs
UCR programs usually allow you to go to the dentist of your choice. These plans pay a set percentage of the dentist’s fee or the plan administrator’s “reasonable” or “customary” fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called “customary,” they may or may not accurately reflect the fees that local dentists charge. There is a wide fluctuation and lack of government regulation on how a plan determines its “customary” fee level.
Table or schedule of allowance programsÂ
These programs provide a list of covered services with an assigned dollar amount. That amount represents just how much the plan will pay for services that are covered, regardless of the fee charged by the dentist. The difference between the allowed charge and the dentist’s fee is billed to you. This is called balance billing.
Capitation programsÂ
Capitation programs pay contracted dentists a fixed amount (usually every month) for each enrolled family or patient. In return, these dentists agree to provide specific types of treatment to you at no charge. (For some treatments, you may need to make a co-payment.) The capitation premium that is paid may differ greatly from the amount the plan provides for the patient’s actual dental care.
Dental Insurance Plans
Dental insurance plans are similar in some ways to health insurance plans, but different in other ways. You’ll generally have the following options:
Preferred provider organization (PPO)
As with a health insurance PPO, these plans come with a list of dentists and other oral health care providers that accept the plan. These are referred to as in-network providers. Going to an in-network provider offers you the lowest out-of-pocket cost. You may have the option of going out of network, but your out-of-pocket costs will be higher than the costs incurred using an in-network provider.
Dental health maintenance organization (DHMO)
Like a health insurance HMO, DHMO plans provide a network of dentists that accept the plan for a set co-pay, or no fee at all. However, you may not be able to see an out-of-network dentist. If you do, you may have to pay the full amount on your own.
Discount or referral dental plan
A discount or referral dental plan offers you a discount on dental services from a select group of dentists. Unlike health insurance, this type of plan doesn’t pay anything for your care. Rather, the dentists who participate agree to give you a discount for the care you receive. These plans are also called access plans or savings plans.
Private dental insurance
Private dental insurance is insurance you purchase on your own, and not through an employer. You can purchase private dental insurance directly through a dental insurer, HealthCare.gov, or an insurance broker.
Call now to speak with a licensed insurance agent at
(800) XXX-XXXX TTY 711
Secure your family’s future today. Let us guide you through your life insurance options and provide peace of mind for you and your loved ones.
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