Being In The Know When It Comes To Your Dental Insurance Coverage
Dental plans generally focus on prevention as an integral component of good dental care (from a professional such as Barberio Frank DMD PC). But dental plans differ in the coverage they provide. Therefore, to get the most out of your dental coverage, you need to understand the benefits included in your plan. That way, you can avoid costly surprises if you know what's covered before you go to the dentist.
Types of Coverage
Diagnostic and Preventive Procedures. Dental plans generally pay 100 percent of the cost for routine dental checkups, which usually include professional teeth cleanings along with dental examinations. Some plans also cover tooth sealants as a preventive procedure. But whatever procedures your plan covers, the goal is to provide preventive care and early treatment of dental problems to prevent the need for more complex and costly treatments in the future.
Basic Dental Procedures. Although your dental plan may not pay the entire cost of x-rays, fillings, fluoride treatments, extractions, root canals, and treatment of periodontal disease, it still may pay a significant portion – usually 80 percent. Major dental services, such as tooth implants, bridges, orthodontic treatment, and dentures, typically pay a much lower percentage of the cost – often no more than 50 percent.
Network Option Plans
Some dental insurance plans are designed to allow you to choose a primary care dentist from a network of participating dentists – those who agree to charge lower fees – which saves you money in out-of-pocket expenses. Although your plan may allow you to visit an out-of-network dentist, you may have to pay higher dental fees and submit your dental claims to the insurer yourself.
Know the Details of Your Benefits
Although your dental insurance is a contract that provides coverage for dental expenses, sometimes policy benefits can be confusing. It helps to read the plan handbook, which outlines the details relating to what your dental insurance plan provides.
Deductibles. Typically, dental plans require you to pay a certain amount before the insurance will cover any of your expenses. Plans vary on deductible amounts and to what services the deductible is applied.
Benefit Period. Dental plans usually pay benefits for a specified period of time; however, that period may not be the typical calendar year, which begins in January and ends in December. It's important to know your plan's particular benefit period when calculating deductible payments or annual maximums.
Annual Maximum. Your dental plan will pay a maximum dollar amount toward your dental care during your benefit period. If your dental expenses within that time exceed the annual maximum indicated in your plan contract, you will have to pay the difference.
Coinsurance. Some dental plans pay a predetermined percentage of the cost of the dental services you receive. You must pay the balance out-of-pocket even after you have paid the required annual deductible in full.
Limitations/Exclusions. Most dental plans do not pay for every dental service you have. Your dental plan may exclude coverage of certain types of dental procedures or limit the number of dental visits you are allowed within the benefit period.
Preauthorization. Major dental procedures that cost more money often require preauthorization from the insurance company. Your dentist will need to provide details of the procedure and explain why you need it. The insurer then will decide whether it will pay toward the cost.