Do you have dental insurance, or are you considering getting some? Approximately 77 percent of Americans do, according to the National Association of Dental Plans. But just because the majority of people have dental insurance, it doesn’t mean they understand it.
While dental insurance can help cover the cost of dental exams and procedures, it doesn’t always work the same as medical insurance. Some dental plans act more as a financial “aid” and don’t fully cover any dental expenses, even after you reach a certain out-of-pocket cost.
If you’re unfamiliar with dental plans and how they typically work, here’s what you should know:
Coverage usually falls into 3 buckets
When choosing a dental plan or learning about the dental plan offered to you through your employer, pay close attention to coverage details. Most plans divide dental work into three categories:
- Preventive (i.e. teeth cleanings and exams, X-rays, etc.)
- Basic (i.e. tooth extractions and fillings, etc.)
- Major (i.e. root canals and dental crowns, etc.)
The majority of dental plans follow the 100-80-50 coverage structure — 100% coverage for preventive procedures, 80 percent coverage for basic procedures, and 50 percent coverage for major procedures. Keep in mind these numbers can vary, so look at your specific plan to be sure.
Fillings are usually covered…depending on the type
One of the most common dental procedures is teeth fillings for cavities. But did you know that many dental plans only cover a percentage of certain types of fillings? For example, most dental plans will only cover amalgam (silver) fillings, not composite (tooth-colored) fillings. That means you’ll be paying more out-of-pocket if you want to avoid metal fillings.
Pay close attention to the fine print in your dental plan because certain procedures may be time-sensitive. For example, your plan may state that it pays 100 percent of the cost of X-rays, but only when taken once every three years. If you have X-rays done multiple times within that time period, you may be stuck footing the bill for the subsequent imaging.
Also, many dental plans support the recommended cadence of teeth cleanings every 6 months, but again, pay attention to verbiage. Your plan might specify it covers these preventive procedures twice within a 12 month timespan, once every 6 months, or twice per calendar year. If you schedule your cleanings too close together, therefore, you could risk having to pay for one of the cleanings out of pocket.
If you find that your dental plan won’t pay for the cost of a certain procedure that they’ve covered in the past, it may be a frequency/timing issue. Check with your dental plan on these details before you have any dental work done.
Costs are often capped
Some dental plans have an annual maximum amount they will pay towards your dental costs. That means if your costs go over a certain amount, you will have to pay for everything additional. Pay close attention to this when choosing a plan, especially if you know you will have high dental costs in the coming year.
Sometimes orthodontics are covered…sometimes not
Do you suspect yourself or a member of your family will need braces in the future? Check with your dental plan to see if orthodontic services are covered. Some plans may pay up to 50 percent of the cost of braces after a 12-month waiting period, while others pay nothing. And since braces can be quite expensive, it’s smart to look into this coverage in advance.
It’s always a good idea to get a full understanding of your dental insurance before using it. There could be fine print about common, everyday procedures that you assume are covered, but actually aren’t. And if you have any questions or concerns about your dental coverage, contact the insurance company for clarification.