Approximately 77 million Americans have dental benefits with most having private coverage through an employer or group program. Since dental insurance doesn’t work the same way as a typical medical insurance plan, it isn’t always the easiest thing to navigate. To fully maximize your coverage, it pays to know a little bit about your plan. Read on to learn about the most common types of insurance plans and what you can expect yours to include.
Why Types of Dental Insurance Plans Are Out There?
There are a few different types of dental plans out there. Here are some of the most common ones:
- Dental Health Maintenance Organization (DHMO): With this insurance plan, your insurance provider will give you a list of dentists that will accept your plan for a set co-pay or no fee. However, you won’t receive any coverage if you see a dentist that’s not on this list of in-network dentists.
- Preferred Provider Organization (PPO): A PPO plan gives you the option to choose whatever dental provider that you like. You will still have a list of dentists who are in-network with your insurance plan, but you can choose one that is out-of-network as well. However, if you do this, you are more likely to end up with higher out-of-pocket costs.
What Does Your Dental Insurance Plan Cover?
The most common dental insurance plans follow a 100-80-50 coverage structure. Typically, this means that they will cover the following dental treatments and procedures:
- 100% of Preventive Care: This includes regular cleanings, checkups, routine X-rays, and more.
- 80% of Basic Procedures: Basic procedures are fillings, gum disease treatment, and other non-invasive procedures.
- 50% of Major Procedures: Things like root canal therapy, dental implants, crowns, and orthodontic treatment often fall into this category.
5 Dental Insurance Terms You Should Know
- Coinsurance: If you have a fee-for-service plan, this will pay a predetermined percentage of the cost of your treatments and leave you responsible for paying the remaining amount. This part of your out-of-pocket cost is known as “coinsurance.”
- Copayment: If you have a closed network, prepaid, fixed copayment plan, you will pay a set dollar amount for covered services instead of a percentage.
- Deductible: This is the amount that you pay every year out-of-pocket before your insurance begins to cover treatment costs. This doesn’t usually apply to diagnostic and preventive treatments.
- Dual Coverage: For patients who have benefits from multiple plans, this is called “dual coverage.” However, the total amount paid cannot exceed 100% of dental expenses.
- Maximum: This is the most money that your plan will cover within one benefit period. The remaining costs will be left to you.
Now that the year is coming to an end, your unused benefits will not carry over to 2023. If you need dental treatment or it’s been a while since your last checkup, there’s no better time to schedule an appointment. This way, you won’t need to worry about your deductible until later on. Use your benefits before they disappear!
About the Author
Dr. Salari is an experienced prosthodontist that has been working in the field for over a decade! She graduated from the Université Libre de Bruxelles before pursuing a Prosthodontics residency in Europe. She has also completed a 3-year residency in the United States at Nova Southeastern University in Ft. Lauderdale, FL. To learn more about dental insurance or to schedule an appointment at her office in Annandale, visit her website or call (703) 763-0800.