Everything You Should Know About Dental Insurance

Dr Sukanya Goswami
Sukanya has done BDS. She is a dentist, a blogger, an extrovert, and a travel enthusiast. She is also a spiritual believer. When she is not working, you can find her reading books.

Oral health is one of the essential parts that also determines the overall health and well-being of a person. However, getting dental treatment can be quite expensive sometimes. Dental insurance provides a means of covering your budgets and cost for dental care. Moreover, it makes dental service more affordable for you. Several dental plans cover a range of dental procedures such as preventive care, essential treatment, and major surgeries.

Each dental plan is designed to meet your budget and type of coverage required to take care of your dental needs. Therefore, it is essential to consider all factors that favor your treatment of choice when it comes to choosing the best dental insurance plan. Today’s article will highlight the significance of dental insurance. Furthermore, we will discuss the most common dental insurance plans that cover different procedures.

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What is dental insurance?

Dental insurance is a particular policy that allows people to budget for the cost of dental procedures effectively. Usually, dental insurance policies are more straightforward and specific as compared to medical health insurance. (1)

Moreover, it helps to cover the cost of any unexpected dental surgery or emergency dental treatment.

What is generally covered under dental insurance?

Usually, the dental insurance policies provide full or partial coverage for the following dental procedures –

  • Preventive care – this includes routine teeth cleaning and fluoride treatments for children under the age of 16 years.
  • Minor dental services such as tooth fillings and emergency tooth repair (2)
  • Major surgeries such as root canal therapy, tooth extraction, and orthodontic treatments.
  • Coverage for prosthodontic rehabilitation with dental implants, bridges, or dentures.

What are the most commonly used dental insurance plans?

Typically, there are three types of dental insurance plans that are commonly used –

Preferred Provider Organization

PPO, also known as a preferred provider organization, is usually an insurance policy that is tied up with a network of dentists under contract with the insurance provider. This policy allows dentists to provide specific treatments for set fees. (3)

Dentists who are a part of the contract accept a maximum allowable fee as per the plan. However, non-contracted dentists have the flexibility to get a fee that is higher or lower than the plan allowance.

Dental Health Maintenance Organization

DHMO is also known as capitation plan contracts dentists that work on commission for each patient that gets assigned to them. The dentists then provide contracted services at no-cost pr reduced cost to those patients. However, a person who wants to take benefit of this plan must receive treatment from a DHMO contracted dentist only.

Indemnity plan

Also known as traditional dental insurance is a policy in which the insurance company pays claims based on the type of procedure performed. Usually, the payment is made as a percentage of the charges. Indemnity plans allow the patients to choose their dentist. However, the dentist must be paired with a Preferred provider organization (PPO). (4)

Most of the indemnity plans have maximum allowance referred to under UCR – usual, customary, and reasonable fees.

Direct reimbursement

These policies reimburse a predetermined percentage of the total cost of a  dental procedure. Typically it does not exclude coverage based on the type of treatment needed. However, it allows patients to go to the dentist of their choice. Moreover, it provides incentives for patients to work with the dentist in harmony.

Table or Schedule of Allowance programs

These policies determine a list of covered services with an assigned cost of treatment. This coverage determines how much the plan will pay for the listed services that are covered, regardless of the fee charged by the dentist. Usually, the difference between the allowed charge and the dentist’s fee is billed to the patient.

What should you consider before undergoing a dental procedure?

It is best to always read the insurance policy guidelines and clauses before signing up for one. Check whether the most common and frequently performed dental procedures are covered in the policy. You can also call the insurance company and clear your doubts.

It is best to ask your dentist about the estimated cost of treatment to check if you have to ow a co-insurance or deductible. Also, ensure if your dental insurance covers emergency treatments. While comparing the different insurance plans, it is best to keep the following points in mind –

  • Check if your trusted dentists and specialists are in the network plan
  • Check the total cost of the insurance plan per annum, which should include premiums, co-pays, and deductible amounts.
  • Check the annual maximum amount of the insurance policy.
  • Check the limitations of the policy.
  • Emergency treatment coverage is an added benefit to take care of your dental needs at the time of the traumatic accident (5)

What is the monthly cost for dental insurance?

On average, dental insurance premiums from an employer-sponsored plan costs between $14 and $30 per month, which accounts for $168 to $366 per year.

  • Family insurance coverage costs between $27 to $56 per month, or in other words – $325 to $680 per year.
  • usually, individual policies cost around $15 to $50 per month. (6)

Take away message

Dental treatments are usually expensive when the patient has to pay out of his pocket. Dental insurance policies are a safer way of covering the cost of essential dental services at an economical rate. Moreover, it provides monthly and annual benefits to the patient.

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Usually, dental insurance covers a range of dental services such as tooth fillings, root canal treatment, tooth extraction, routine check-ups, periodontal and prosthodontic treatments.

There are several dental insurance plans which ha person can choose from depending on their needs and requirements. The best way to select a dental insurance plan is to check if all the essential and emergency dental treatments are covered in the plan. Check the feasibility of choosing your dentist. Moreover, keep track of the monthly and yearly costs of dental insurance.

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