How does dental insurance work
A good dental plan can help you manage the cost of dental care, encourage visits to the dentist and give you peace of mind. But how exactly does it work? Is dental insurance the same as health insurance?
Let’s take a look at what dental insurance does and how it does it, and common terms you need to know.
Coverage 101: Understanding dental insurance
In many ways, dental insurance is a lot like regular health insurance. You pay a set dollar amount each month to your insurance provider, and when you visit the dentist, your plan helps cover a portion of the cost.
Dental insurance often covers 100% of preventive care services, like checkups, X-rays and cleanings. It also often covers a set percentage on basic and major procedures, such as fillings, simple extractions, root canals, crowns and complex extractions.
When looking for a plan, it’s important to know what language insurers use to explain the extent and limitations of your coverage. A better understanding of your plan can help you get the most out of your care. Here are some terms you need to know.
Dental insurance deductible
A deductible is the amount of money you pay for dental care before your plan starts helping with costs. Most, if not all, non-preventive dental services have a specific deductible amount tied to them. Once you pay that sum, your insurance kicks in and starts covering a percentage of the remaining cost. Deductibles are usually listed for each service on your plan’s summary of benefits, which is the detailed coverage breakdown you approve when enrolling.
Coinsurance is the percentage you pay for a service after your deductible has been met. Many plans cover basic, non-preventive services at 80%. In this situation, once you pay your deductible, your insurance pays 80% of the remaining cost of care. The remaining 20% is up to you to pay as your coinsurance.
Annual maximum benefit
Your annual maximum benefit is the total amount that a plan will pay for dental care within a specific benefit period – usually a calendar year. Annual maximum benefits reset each year and often range from $1,000 to $2,000 per person. Unless a patient needs extensive dental work, they do not usually meet their yearly maximum.
Dental waiting period
Your dental waiting period is the amount of time you must wait before you’re able to receive benefits either for all treatments or for specific, often expensive treatments like crowns. Depending on the plan, this waiting period can range from a couple months to up to a year. However, most often, routine checkups and cleanings are covered immediately.
So, why are waiting periods often part of coverage? They serve as protection for the dental insurance company. They typically apply to more expensive treatments to help prevent people from seeking insurance in response to learning of the need for a crown, implant or similar, often urgent, dental procedure.
Waiting periods can sometimes be waived if you’re able to show you’ve had continuous coverage from one dental plan to the plan you’ve recently switched to.
What are the different types of dental insurance?
While there are many different types of dental plans, it’s best to start your search by narrowing down where you can get dental insurance. You might be offered a dental insurance option through your employer, or you can buy a plan on your own – both individual and family.
Discount plans are also an option. With these, your insurer helps you get discounts on services instead of contributing to care costs. Also, if eligible, you might be able to get coverage through a Medicare Advantage plan.
Have more questions about dental insurance?
Learn about HealthPartners dental plans and what kind of coverage best suits your needs.