Dental Insurance Plans

Dental Coverage

A majority of people take private coverage from a group program or their employer, but most have benefits with no idea what’s in the fine print. You should note that the term “dental benefits” is different from insurance. While an insurance plan is meant to absorb risk and cover costs accordingly, a benefits plan covers some things only partially, others in full and others not at all. It’s meant to help you in some way but not the whole way. Save yourself the trouble by considering what your plan is before going in for a Midtown dental care treatment. Ensure you understand what your plan covers.

Types of Plans

Generally, dental plans are similar to typical healthcare plans and different than others. The different types include Preferred Provider Organization (PPO), Dental Health Maintenance Organization (DHMO), and discount or referral plan.

With a PPO, the plan comes with a list of dentists who can accept it but your out-of-pocket costs will be higher. You also have the option of going out of network. The DHMO plans also provide a network of dentists that accept the plan for no fee at all or for a set co-pay, but you will not be able to see an out-of-network dentist. With the discount or referral dental plan, you’ll get a discount on a select group of dentists but the referral plan will not pay anything for your care. The dentists themselves who participate will agree to give you a discount for the care received.

What They Cover

You’re normally covered for 2 preventive visits annually. The dental plan will generally cover some portion of the cost including root canals, crowns, fillings, and typical preventive care as well as oral surgery such as tooth extractions. They might also cover prosthodontics such as bridges and dentures, periodontics or structures that surround and support the teeth, and orthodontics. Prosthodontics and periodontics may not be available for an individual policy.

Most dental plans will subscribe to the 100-80-50 coverage structure, where preventive care will be covered 100%, while basic procedures and major procedures will be covered at 80% and 50% respectively. The dental policy may also choose not to cover some procedures at all, for example, sealants. Generally, every policy has a cap or ceiling for what they will pay every year. For many companies, that cap is low. Every other expense that goes beyond that amount will be paid out-of-pocket. That maximum cost can be reached quickly if you need a procedure such as oral surgery, root canal or a crown.

Timing

Most experts advise people to see their dentist twice per year, which is supported by most dental benefit policies. However, the wording varies and this may mean something different for everyone. For instance, it may mean that you separate your visits by a certain number of months. It’s important to understand your policy so you can schedule your appointments correctly. The time limits also vary with the procedure, for instance, X-rays may be paid only once every two years.

Sometimes, your dental condition may not be covered by the dental plan or may not have existed before you enrolled. This will force you to pay your expenses out of pocket. Ensure you read your dental policy closely so that you know if your procedure is covered.