Many patients understand the importance of keeping up with their twice-yearly teeth cleaning exams, and practicing good oral hygiene habits at home. But one common question we get from patients at our dental office in Clintonville, Ohio is, “Is my dental insurance accepted?” and, “What does my dental insurance cover?” While nearly every dental plan is different, we can give general insight into Ohio dental insurance providers and benefits available to patients.
Ohio Dental Insurance Providers and Benefits Overview
Insurance can be very confusing, especially when it comes to dental insurance. This type of insurance is typically an add-on benefit to general health care or medical coverage, so many patients will choose what works best for them first on their medical insurance, then opt-in to dental benefits.
Dental insurance benefits tend to have some commonalities with general medical insurance (e.g. both likely have a deductible you will need to meet). But because dental care is usually more routine than medical care, there are some notable differences.
Ohio Dental Insurance Providers
Our goal is always to give our patients the care they need, which is why we accept a wide range of Ohio dental insurance providers, including the following:
- Superior Dental Care
If you don’t see your provider on this list, not to worry, we may accept additional Ohio dental insurance providers. Call and ask us any time about your dental insurance, especially if you are a new patient or your insurance has recently changed. We also offer in-house payment plans for certain procedures and treatment plans. We are happy to sit with our patients anytime to discuss their individual insurance benefits and financial options for treatment.
Common Ohio Dental Insurance Benefits Definitions
Next, we want to cover some general definitions you should know and understand about your dental insurance benefits.
Dental insurance deductible
A dental insurance deductible is the minimum amount you must pay out of pocket before your dental insurance will pay for any of your procedures or treatment.
In Ohio, most dental insurance plans have a deductible of $200-$500 (though some can be significantly higher). So if your procedure total is $600, and the procedure itself is covered at 100% by your dental plan, you would owe $500 out-of-pocket on the day of the appointment, and your insurance will pay the remaining $100. For the rest of the year, after your deductible is met, you will not be required to pay this deductible again until your plan renews.
Please keep in mind that many Ohio dental insurance plans cover procedures like fillings or root canals at 80%, even after your deductible is met. So even after you pay your deductible, you will still need to pay 20% of the procedure cost and your dental insurance will pay 80%. This is called co-insurance, which we will explain in more detail below.
If you’re ever unsure what your dental insurance provider covers, or at what percentage, you can always speak to your HR department, call your dental insurance provider directly, or ask your dental office to call. We always recommend doing all three, so that you’re absolutely sure about what your dental benefits cover and you don’t get any “surprises” after your procedures.
Dental insurance co-pay
A co-pay is an additional set amount you may be required to pay for each dental procedure, even after you meet your deductible. Not all Ohio dental insurance providers require a co-pay, but some do.
Co-insurance is the percentage your dental insurance plan may require that you pay for procedures. For example, if your filling is $200 and your insurance pays 80% of the filling and you pay 20%, you will owe $40 at the time of service, and your dental insurance will pay $160.
Dental insurance care categories
Most Ohio dental insurance providers divide dental care and procedures into three separate categories: preventative, basic and major.
- Preventative dental care (may also be called Type I) is a category for your twice-yearly cleanings, x-rays and/or sealants. Make sure you understand your preventative dental care schedule carefully, as some Ohio dental insurance plans allow for cleanings twice a year or once every six months (see more detail on these definitions below).
You will also want to check on how often your dental insurance will cover dental x-rays and sealants. Most plans will cover one full set of x-rays per year, but will require that you pay for any additional x-rays. Also, most plans will only cover sealants once a year, as well. Always double check before each appointment!
- Basic dental care (may also be called Type II) is a category for fillings, root canals, gum disease treatment and extractions. Depending on your deductible, co-pays and co-insurance, you may pay anywhere from 10-80% of the procedure cost. Some Ohio dental insurance benefits do cover basic dental care at 100%, but not all. Most have an 80/20 split, with patients paying 20% of the cost of the appointment (even after the deductible is met).
- Major dental care (may also be called Type III) is a category for crowns, bridges, inlays, onlays, dental implants and dentures. It is the very rare plan that covers these procedures at 100%. Most Ohio dental insurance plans cover them 50/50 or 60/40, and some cover them at even less.
Always double check your plan to see how your individual insurance provider categorizes procedures and treatments. Some Ohio dental insurance providers consider root canals as major dental care, while others don’t. Some dental plans may pay more or less for certain materials (e.g. a gold crown vs a ceramic crown). Again, it pays (sometimes quite literally) to pay attention to your plan and its specific parameters.
Some Ohio dental insurance providers have a cap on how much they will pay for procedures each year. If you know you have a big year of dental work ahead of you, double check on your dental insurance provider’s yearly maximum as you and your dentist go over your treatment plan.
An in-network provider is a dentist that is in your insurance provider’s network. Choosing an in-network provider means you have a dentist who not only accepts your insurance, but that you also have an insurance plan that will provide their best benefits within the plan.
An out-of-network provider can often still accept your dental insurance, but they are not in your insurance network. That means there is often a penalty and your dental insurance will cover less (or nothing at all) than they would with an in-network provider.
Some Ohio dental insurance providers require a waiting period before they cover any basic (Type II) or major (Type III) dental work. This waiting period can be as much as six months to a year.
“Twice a year”
This is a stipulation for cleanings that some Ohio dental insurance providers require. If you are allowed dental cleanings twice a year, that means you may receive two cleanings any time in your calendar or fiscal year.
“Once every six months”
This is a different stipulation for cleanings that some dental insurance providers require. If you are allowed cleanings once every six months, you are limited to receiving one cleaning in a six month period, and not a day sooner.
This is another term used to describe an employer-provided plan, or a plan provided company wide.
Preferred Provider Organization (PPO)
This is another term for an in-network group of providers. Some Ohio dental insurance plans may also be categorized with this acronym, and will provide vastly different benefits from a similarly named insurance provider. For example, a Humana PPO plan might provide extremely different benefits than a Humana dental plan without the PPO designation.
Discount dental plan
These plans are not technically insurance, and will typically behave differently than an insurance plan. If you have a discount dental plan, make sure your dental provider accepts it before assuming you can reap the benefits of your plan at your next appointment.
Other Ohio Dental Insurance Items to Note
Most Ohio dental insurance plans do not cover cosmetic procedures like dental veneers or teeth whitening. Also, some do not cover orthodontic treatment, and if they do, they will likely require a separate orthodontic treatment deductible, co-insurance and have a lifetime maximum benefit.
If you don’t have dental insurance or have little dental insurance coverage, many dental offices will accept payment plans through programs like Care Credit or provide in-house payment plans and solutions. Some patients who need major dental work and have a large deductible and co-insurance responsibilities may choose to use both their insurance benefits and a payment plan to cover the cost of their treatment.
Remember: The above information is to be used as general guidelines and you should not use this information to diagnose yourself. If you are concerned about your teeth, you should contact our Clintonville, Ohio dentists for a thorough dental exam.
Dental Insurance Plans and Dental Treatment in Columbus Ohio
We are proud to preventative, basic and major dental to our patients in Central Ohio and accept many Ohio dental insurance plans. Contact us today to learn more!