It is hard to believe that the year 2017 is already coming to an end. The holidays are upon us, and this year will be over before we know it. In the hustle and bustle of these busy days, it can be easy to forget that certain things expire at the end of the year. In many cases, one of those things is your dental insurance!
How is Dental Insurance Different From Other Insurance?
Comparing dental insurance to medical insurance is like comparing apples to oranges. Many people understand a deductible in terms of medical or even auto insurance, meaning once you reach your deductible, most everything else is covered. Dental insurance is completely different.
If a deductible is required at all, it is usually minimal. Most deductibles are around $50-100 and are reached at your initial visit with the dentist. The difference with dental insurance is that once you meet your deductible, you still have to pay for most dental procedures.
Dental insurance plans have a maximum payout amount, which is usually in the range of $1200-2500. Once your insurance company has paid the maximum amount, 100% of any additional fees incurred at the dentist are your responsibility.
What Different Types of Dental Insurance are Available?
There are literally thousands of dental insurance plans available today. This article will address the general types of insurance plans rather than attempt to explain in detail each different plan.
DHMO – Dental Health Maintenance Organization – Also known as DMO
ProsConsContracted fees are greatly reduced
Typically little to no waiting period on coverage
May have no annual maximum
Low annual premium
Benefits are only provided at in-network practices; patient will not receive any benefits if they choose to go to an out-of-network dentist
May be difficult to find in-network dental practices
Patient can receive benefits with an out-of-network provider
Most dental procedures covered
May have waiting period for coverage
Yearly maximums apply
High annual premium
Dental Discount Plans – Also known as a referral plan, the patient becomes a member and then pays fees negotiated by the referring company and the dentist.
ProsConsThe patient pays a discounted fee for dental procedures
No annual maximum
Membership fee, usually annual
Limited number of dental practices participate
All fees incurred are the patient’s responsibility; there is no third-party payer.
I Have Dental Insurance, So How Much Will This Cost?
The amount you pay depends on several factors:
The dentist’s fee for the procedure – Each dental practice has a set fee for every procedure they provide. This is the price you pay if you have no dental insurance. For the sake of simplicity, let’s say a professional cleaning at your dental office has a fee of $100. You would pay $100 with no insurance.
Whether or not your dentist is in-network with your specific insurance plan – If your dental office is in-network with your specific insurance plan, the fee for a procedure is often reduced to a rate agreed upon between the dentist and the insurance company. An example of this is that by being in-network, your dentist is agreeing to charge the contracted fee of $90 for a professional cleaning, rather than the $100 fee set by the practice.
A percentage of the fee your insurance covers as part of your dental benefits – All of the dental procedure codes are divided into categories, and the insurance company gives fixed percentages that it will pay for each category. For instance, a professional cleaning falls under the Preventive category, which is paid at 100% in many plans. In this case, your insurance company would pay your in-network dentist $90 for the cleaning. You would pay nothing. If your plan covered only 90% of preventive procedures, you would be responsible for 10% or $9, while the insurance company covered 90% or $81.
Whether or not you have reached your dental insurance maximum – If you reached your maximum earlier in the year, and you have a professional cleaning performed at your dental office, you are responsible for the entire contracted fee of $90.
How many times a particular procedure is allowed within a set time frame – There are often time limits set for a specific procedure. It is common for a dental insurance plan to pay for two professional cleanings per calendar year. A patient in need for more frequent cleanings may have more out-of-pocket expense. This also applies to the replacement of dental work. For example, your insurance company may specify that it will only pay for a crown on a certain tooth once every 5 years.
What Important Things Should I Know About My Plan?
When is your insurance “year”? Most follow a calendar year, but there are some plans which follow a different schedule, like July-to-June. Most people will lose any unused benefits after December 31, but if you have a July plan, your benefits would expire on July 31.
What is your deductible, if any? Be prepared to pay this amount at your first visit.
What is your yearly maximum? Knowing this will help you prioritize and schedule your dental treatment.
Do you have a waiting period? This is important to know so that you do not inadvertently proceed with dental procedures that will not be paid for unless you wait the prescribed amount of time.
This is Confusing! Where Do I Begin?
First, find a dentist. If you want to stay in-network in order to get the most out of your dental insurance benefits, call your insurance company or visit their website to find out which dental practices in your area are in-network. If you have already decided on a dental practice, call their office to find out if they are in-network with your dental insurance. Understand that if they are not, you will incur higher fees.
Next, give the dental office your insurance information so that they can verify your benefits and be ready for your first visit.
Lastly, make an appointment as soon as possible so that you can get the most out of your benefits. If you don’t use them, you lose them.
