What You Need to Know about Dental Insurance

If you’re like many adults, you may sometimes take your dental health for granted. Foregoing regular dental care can not only have serious health consequences, it can also be a bad financial decision. According to a 2019 survey by the National Association of Dental Plans, approximately 47% of adults participate in employer-sponsored dental insurance plans but many, in turn, don’t make use of this benefit. Less than half of insured adults actually use their dental insurance and a mere 4.2% reach their annual maximum. With the average annual cost of dental insurance for an individual at about $360 a year, it just makes sense to get the most out of that investment. To help you better understand dental insurance and dental benefits plans, we’ve pulled together some essential information you should know.

Don’t let your dental insurance go to waste.

Health insurance is both expensive and confusing which causes many of us to simply adopt an avoidance strategy when it comes to understanding the details. Dental insurance is a different animal altogether, so it pays to understand the differences.

Dental benefits versus insurance.

Dental insurance doesn’t work like other insurance types. An insurance plan is set up to cover a loss and the insurer carries the risk. So, your homeowner’s insurance will reimburse you if you lose your home to a fire or natural disaster and if you total your vehicle, your car insurance pays you the value of your car. Dental coverage is set up as a benefit plan-it will cover certain costs up to a maximum amount. For example, free preventative care (exams, cleanings, and X-rays), $1,500 to $2,000 annually for restorative procedures (fillings, crowns, etc.) and a $1,500 to $ 2,000-lifetime benefit for orthodontics are typical max thresholds. It’s even possible that some procedures recommended by your dentist won’t be covered at all by your dental benefits plan. The vast majority of dental plans are based on care delivered within a calendar year. What you don’t use in that year, you lose. Also, dental insurance deductibles tend to be quite low, often under $100, which makes this less of a deterrent than comparable health insurance plans.

What does dental insurance cover?

In the majority of cases, while many dental benefits cover preventative care (two cleanings and two dental exams per year), most won’t cover other services at 100% because they are designed around annual maximum benefits vs. a cost-of-care model. When you sign up for dental insurance, be sure to understand what is covered by your benefits and what you will be responsible for. Here are some of the terms you might see:

• Deductibles: This is the amount you will have to pay before your plan will begin to pay. Typically, there is no deductible to meet when you get preventative or diagnostic services but be sure to verify what your plan covers.
• Annual maximums: Your plan will only pay up to a certain limit each year. Therefore, if you have dental expenses of $2,500 in a plan year, but your plan covers $2,000, you would have to pay out of pocket for the $500 difference. This is also after you had paid for any deductible.
• Coinsurance: Coinsurance is the percentage of the charges that you are responsible for paying. For example, a 60/40 plan would mean your benefits provider would handle 60% of the charges for a service and you would pay the remaining 40%.
• Least expensive alternative treatment (LEAT): Some plans have a LEAT clause. If yours does, this means if there is more than one option for treatment, the plan will cover the least expensive one.
• Pre-existing conditions: It’s important to understand how pre-existing conditions are handled by your dental benefits plan.

In most cases, dental benefits plans will require you or your provider to submit a treatment plan for prior authorization before any services are completed. If you have any concern that a procedure might not be covered, it’s always a good idea to run it by your plan’s administrator who will review the treatment proposal, determine the patient’s eligibility for the procedure, the co-payment that will be required, and the max amount to be covered.

Types of dental plans.

When shopping for a dental plan it’s easy to get discouraged by all the acronyms that fly around. PPO to DHMO can leave you with FOMO (fear of missing out) on what might be a better plan and exclaiming OMG! Never fear, here are the most common types of plans:

• Preferred Provider Organization (PPO): You might be familiar with the PPO term from health insurance enrollment. When you are part of a PPO dental plan, you must go to a dentist within the PPO’s network to get your full benefit. These dentists have agreed to the PPO’s established fees for services. The services that are covered depends on the PPO plan. And if you receive any services from an out-of-network dentist, you can expect to pay in full since the PPO will only cover services performed by an in-network provider.
• Dental Health Maintenance Organization (DHMO): As the name suggests, a DHMO is like a health insurance HMO. Dentists who are part of the DHMO network receive a monthly fee to cover dental services for you. Services are either free or require a co-payment. Providers get paid monthly regardless if you see a provider or not.
• Discount Plans: Dental discount plans are another great way to cover preventative care and save money on restorative services. Plans like our OneSmile Dental Plan require a low annual membership fee which provides members the ability to receive free dental exams and 20 to 40% savings on needed services. These plans are often combined with insurance to bring down costs for non-covered treatment.

What you should know to get the most from your plan.

Whether you already have dental insurance or are trying to assess the best dental coverage for you and your family, you will want to get the most for the benefits you purchase. Keep in mind, you can only benefit from dental insurance if you actually take the time to visit the dentist. Here are some important tips for getting the most out of your plan:

• Whether you already have dental insurance or are trying to assess the best dental coverage for you and your family, you will want to get the most for the benefits you purchase. Keep in mind, you can only benefit from dental insurance if you actually take the time to visit the dentist. Here are some important tips for getting the most out of your plan:
• Be sure to select an in-network provider, or, if you are on a Dental HMO plan, visit only the office to which you’ve been assigned.
• Understand your premiums. Dental insurance is typically a separate enrollment in employer healthcare plans. The average cost per individual is $170-$370 a year while a family typically spends $325-$800 a year. Calculating your annual premium cost will boost your motivation to make use of your benefits.
• Verify benefits coverage before making treatment decisions. Your dentist should quote you treatment costs specific to your remaining coverage, so you can make the most informed decisions about your dental care options.
• Find out if your plan offers orthodontic coverage. The perfect smile may be more affordable than you think.
• Find out how the plan handles emergency out-of-network treatments.
• Beat the end-of-year rush. Many people forget to book dental appointments and then have to scramble to take advantage of their benefits before the year ends. Book early to be sure you have an appointment reserved before time runs out.