Understanding Your Dental Insurance Plans and Coverage

Dental insurance is meant to reimburse a portion of the costs related to preventive dental care and treatment of dental disorders. Nowadays, many different types of dental insurance plans are offered to individuals and groups according to their needs. 

You may have a dental insurance plan but find it tricky to figure out exactly how it works and what it includes. Here’s a brief guide to decoding your dental insurance plan. 

Understanding Your Dental Insurance

Where Can You Access Dental Insurance?

According to the National Association of Dental Plans (NADP), around 90% of Americans have private dental insurance through their work or another organization. Group dental insurance is also the lowest priced dental coverage because employers procure them at a group rate, and they mostly pay a share of workers’ premiums. There are other non-employer group plans, including group dental insurance by the American Association of Retired Persons (AARP) for its members.

For many individuals who are not offered any dental insurance by their employers, they can consider the private individual insurance plans as an alternative. You can buy them either on dental plan websites or through trusted insurance brokers. Individual plans will meet your dental bill payment needs exactly like group dental plans, but with some additional rules.

How Does Payment Work?

In contrast to health insurance, which people trust for managing the costs of big healthcare bills, dental insurance mainly focuses on covering relatively inexpensive, preventive treatments. In general, most dental plans will cover:

  • 100% of the expense of preventative care like cleanings, checkups, and X-rays
  • 80% of essential treatments including fillings
  • 50% of more complicated and costly procedures like root canals and crowns 

In addition to this, usually, you are required to be a member of a dental insurance plan for a minimum period of one year to be qualified for the coverage of costlier procedures, and a maximum period of six months to be eligible for some primary restorative services.

What Is Fee-for-Service?

Fee-for-service programs include direct reimbursement plans that are funded by individual companies. They usually refund employees according to money spent, and not on treatment type. Patients can choose any dentist. Some employers offer direct-compensation dental insurance plans, also called fee-for-service or indemnity plans. Usually, these types of policies will require an employee to pay their consultation charges to the dentist first and then the employee will receive their reimbursement later. In another indemnity plan option under the fee-for-service program, you are allowed to make specific payments for particular services, regardless of actual charges.

What Is Direct Pay?

Rather than buying dental coverage, some people choose to only pay for dental services when it's necessary. This system is used by people who agree to pay a fixed charge per service. It means dental services are paid directly to the dental provider by a patient. 

For instance, a dentist will list regular rates for dental care, including teeth cleaning, dental exam, or X-rays. Among those three services, the dental exam is usually low-cost, while the X-rays are very expensive. The teeth cleaning might cost double, and costlier options like braces and bridgework are also offered à la carte. Patients who use direct pay method have to bear the most significant dental health care costs on a per-visit basis.

Understanding dental insurance is essential to avoid the risk of either overpaying for services provided or overlooking dental care altogether. Carefully go through your coverage plan documents to learn what you have and what you can choose.

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Steffany Mohan, DDS

Dr. Steffany Mohan, DDS is a highly accomplished dentist, speaker, and coach in dentistry and has been practicing for around 22 years in West Des Moines, IA. She is renowned for her achievements in implant practice management and has established Plaza Dental Group as among the busiest and most thriving dental offices in Iowa