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Learning the Basics of Dental Insurance

Learning the Basics of Dental Insurance
Dental insurance is one of the 5 major types of health-related insurance that combine for truly “complete” coverage. Covering all the bases is a wise move, considering the high cost of dental and healthcare costs in our day and age.
As you will see, dental insurance is in some ways similar to other types of insurance but also has some significant differences.

Before you decide on whether to sign up for dental insurance or on which plan is right for you, you’ll want to first learn the basics of how dental insurance works.

Do I Really Need Dental Insurance?
The first question to be answered is “Who can benefit from a dental insurance policy?” You may be wondering exactly what this insurance-type does and who needs this kind of coverage.

There are a number of reasons to invest in a dental policy, including these five:

  1. It could save you a lot of money on dental expenses over the years.
  2. You will be less likely to avoid seeing the dentist promptly when you have a tooth-related issue.
  3. You can often bundle dental insurance with vision insurance to save even more!
  4. Free or highly discounted dental checkups are included, which means you are less likely to develop tooth or gum problems to begin with – aside from spending less to correct them should they occur.
  5. Since dental problems are not normally covered under regular health insurance (except on children’s policies), you need a separate dental policy to adequately protect your teeth.

So who needs dental insurance? Basically, almost anyone can benefit from it. However, note the following groups that might be especially wise to sign up for a dental policy:

  • Anyone approaching the age of 40 or who is older than 40 because those in this age bracket have the biggest risk of tooth loss, gum disease, and other dental problems.
  • Those with a family history of cavities, tooth misalignment, periodontal disease, and other things that may be covered by your dental insurance policy.
  • Anyone who can get dental insurance through their employer or qualify for other group-rate discounts.
  • People concerned to fill in the gaps left by their health insurance policy so as to fully cover all possible health issues – including dental ones, and not get hit by heavy dental bills.

Know The 3 Basic Types of Dental Insurance
Dental insurance comes in all shapes and sizes, and it can be customized in many ways to fit your exact needs and preferences. But there are basically three major types of dental insurance on the market today. It pays to familiarize yourself with how each one of these options works.

You can get individual plans, family plans, or work-based plans. And you can get various levels of benefits. But what we want to look at here is the different ways your policy can be set up.

Indemnity Dental Insurance
First, there are what’s called indemnity dental insurance. Indemnity plans normally work with patients paying the dental bills initially, filing a claim, and then being reimbursed by the insurer for the covered amount.

With indemnity coverage, your insurer pays a specific dollar amount for particular dental procedures based on prices considered “customary” by the ADA. The good news is you can use any dentist you want since there is no network involved. By selecting a dentist with lower prices for each procedure, while the amount paid by the insurer remains constant, you save more money.

Preferred Provider Organization (PPO) dental insurance is extremely popular today. In this case, there is a network of dentists who have joined the PPO in order to gain more patients, while the patients get PPO insurance to access dental discounts and other benefits.

The network is normally quite large with most PPOs, so it’s not as if you are going to have a problem finding a participating dentist near you. You will want to stay in-network, however, to save the maximum amount possible on each dental procedure or visit.

The last major type of dental insurance is health maintenance organization (HMO) insurance. With HMOs, the main benefit is that the premiums and other costs of the insurance are lower. You have to stay in the network, but you can save a lot of money anyway by doing so.

HMO dentists often reduce prices to align with the recommendations of the HMO. HMOs have other benefits too. For example, they often have no wait periods for coverage and no annual coverage caps.

General Benefits & Limitations Of Most Dental Insurance
While there are different types of insurance (the three major types mentioned above), there are also elements that almost all dental insurance has in common. And there are things that may vary from policy to policy but are not restricted to only one of the three major dental insurance types.

First of all, dental insurance involves paying monthly premiums for continuous coverage – just like health insurance. But it costs a lot less since it only focuses on one major are of your health.

There may also be copays and deductibles with some dental policies. There are sometimes waiting periods before you enjoy full coverage. Also, preexisting conditions are not normally covered since that might encourage many to just get a policy once they need a dental procedure done and then drop it right after. (If that happened, of course, premiums would skyrocket.)

The major areas of coverage include dental checkups and tooth cleanings, fillings for cavities, dental crowns, dentures and bridges, periodontal care, root canals, dental implants, oral surgery, and more.

In many policies, coverage is organized as follows:

  • 100% of preventative care is covered. This may include getting routine X-rays and having your teeth cleaned once or twice a year.
  • 80% coverage applies to basic dental procedures like tooth extractions, a filling, or a root canal.
  • 50% is covered with major procedures and dental surgeries. This would include things like periodontal treatment, dental implant surgery, bridges and dentures, or crowns.

Note that only dental procedures considered to be “medically necessary” are going to be covered in most cases. If it is a purely cosmetic issue, it won’t be covered unless you have a very specialized policy set up ahead of time.

Overall, you get substantial coverage on everything you are likely to ever need in regard to dental care over a lifetime. Although every policy is set up a bit differently, they generally cover the same things. The main differences are the balance between premiums and coverage level, whether your insurer pays the dentist or you pay him/her and get reimbursed, and how the fees and procedure-types are structured.

To learn more about how dental insurance works, talk to an experienced dental insurance agent at Flagler County Insurance Agency today!