According to the National Association of Dental Plans, 77% of Americans have dental benefits. That's excellent news because regular dental care is vital for your overall health. Dental problems can lead to other health problems if left untreated.
For example, tooth decay can cause pain and infection that spreads to other parts of your body. Gum disease has been linked to heart disease and stroke. Also, research has shown that people who have periodontal disease are more likely to develop other diseases, such as diabetes and respiratory infections.
Do you know what's covered and not in a dental insurance plan? You must know these things to make the most of your dental insurance.
What's Not Covered?
Since insurance providers are in the business of saving money, they have to be selective about what procedures to cover. That's why it's essential to read your plan carefully and understand what is and isn't covered.
Often, it can be tricky to get insurance to pay for dental procedures you may need or want, primarily cosmetic dental procedures. While some insurance plans do cover them, not all will be.
The reason for this is that they're not medically necessary. These elective procedures include veneers and whitening. Please note that both of them help improve the appearance of a patient, not restoring damaged teeth. Meaning these treatments don't confer medical benefits.
If you need a dental procedure that is considered elective, be prepared to pay for it out of pocket. However, there are still ways to get the treatment you want at a lower cost. Ask your dentist about payment plans or look for dental clinics that offer financing options.
In some cases, you may be able to get your insurance company to cover a portion of the cost. But this depends on the provider and the type of coverage you have. If you have comprehensive coverage, it's more likely that they will pay for cosmetic procedures. However, if you only have basic coverage, you may not be in luck.
What's Covered?
Dental insurance plans usually cover some of the cost of dental services from:
- Basic Dental Care: tooth extractions and cavity fillings
- Preventive care: dental x-rays, teeth cleanings, dental exams, dental sealants, fluoride treatment
- Major Dental Procedures: root canal treatment, scaling and root planning, dental crowns, dental inlays and onlays, dental bridges, dentures
Most dental insurance plans follow a coverage structure of 100-80-50. It means that the plan will pay 100% of the cost for preventive services, 80% of the cost for primary dental care, and 50% for major dental procedures.
Also, there are treatment limitations with most dental plans. These are set limits on how frequently you can use the insurance to pay for procedures. For example, your dental insurance plan may only cover dental exams twice a year, teeth cleanings once a year, and x-rays every two years.
If more of these procedures are needed, you might need to pay for them out of pocket.
Common Types of Dental Insurance Plans
There are many different dental insurance plans available today. Some are HMOs, and some are PPOs. A Health Maintenance Organization (HMO) is a dental health insurance plan covering all your dental care costs. Still, you have to pay an annual deductible before covering any services or procedures.
Dental Preferred Provider Organizations (PPOs) are networks of dentists who have agreed to provide services at a discounted rate. You will usually need to choose a dentist from within the PPO network to receive these discounts.
There are also Medicare plans that can help you cover dental costs. Take note that the available Medicare plans vary in benefits and cost structure. So, make sure to compare Medicare with Assurance.
You can also find dental insurance plans specific to one type of dental care, such as orthodontia or oral surgery. These plans often have lower premiums because they only cover a small portion of the services that you may need.
How Much Does It Cost?
Dental insurance costs can vary depending on the plan you need, where you live, and your coverage level. Also, you will need to pay a monthly premium similar to your health insurance plan.
The good news is that you may be able to find a dental insurance plan for just $20 per month. However, the most comprehensive plans can cost up to $100 or more per month. You will also need to pay a deductible and co-payments for each visit to the dentist.
Closing Statement
Is dental insurance worth it? The short answer is yes. With dental insurance, you'll save money in the long run by paying monthly premiums while receiving coverage for routine procedures that help keep your oral health on track.
Also, if an unexpected dental problem arises, you'll be able to handle it without breaking the bank. And don't forget that having insurance can help your dentist keep tabs on your oral health and identify problems early.