Dental Insurance
Dental Insurance for Individuals and Families
Dental Insurance is not just offered as an employee benefit through work. You might choose your own dental plan if…
if you are age 65 and over and covered by Medicare and supplemental insurance (Medicare and most supplemental plans do not cover dental)
If you are self-employed or a small business owner and must choose your own insurance coverages
If your employee benefits package through work does not include dental insurance
Three Details to Note When Considering Dental Insurance
What is the Annual Benefit Maximum?
The most important benefit of a dental insurance plan is the “annual benefit maximum” which is the most an insurer will pay toward your dental costs in a year. After the annual benefit maximum is met, you are paying for all dental costs until the year is up. A higher annual benefit maximum signals a more benefit-rich plan.
How are Endodontics (Root Canal) Covered?
Insurance companies decide how each dental service is covered in their plan. Look carefully at Endodontics (having a root canal). Most insurers place Endodontics in the Major services category, but others place Endodontics in the Basic services category, ensuring less cost for you!
Is Your Favorite Dentist In Network?
If the dentist you wish to visit is in-network there are many reasons this means the dental insurance plan will be more beneficial to you. Insurance companies do have searchable databases of their network at their corporate web site, so we can see which plans count your dentist as in-network.
We Offer Dental Insurance from Many Companies, Including…
Dental Insurance Benefits
Insurance companies’ plans differ in the details, but most plans follow a model of grouping benefits into 3 categories; preventative, basic and major.
Preventative Services in Dental Insurance Plans….
usually include those “six month visits,” the dental exam, x-rays, and teeth cleaning. Preventative services can also include flouride treatments and sealants for children and teenagers. Though there are always exceptions, dental insurance covers preventative services at 100%.
Basic Services…
usually include extractions, fillings and stainless steel crowns. Basic services, depending on the dental insurance plan, are usually covered at either 60%, 70% or 80%, after any deductible on the plan is met.
Major Services…
usually include porcelain crowns, dentures, bridges, endodontics (root canals), oral surgery, inlays and onlays. These dental services are covered at 50% by a majority of dental insurance plans, after any deductible on the plan is met.
Annual Deductible
Some dental insurance plans contain an annual deductible you must pay before benefits begin. Note that this annual deductible does NOT apply to preventative services. But if you utilize basic or major services you would pay the dental costs up to the deductible amount (usually $50 or $75), then the insurer would begin to pay their percentage of benefit for ongoing dental services.
Annual Benefit Maximum
All dental insurance companies have an annual benefit maximum, which simply means the most benefit the dental insurer will pay towards your dental expenses in the year. The standard annual benefit maximum is $1,000 per covered person, though some plans feature higher amounts ($1,250 or $1,500). If you meet your annual benefit maximum in the plan year, the dental insurance company pays nothing more toward your dental expenses until the new plan year begins.
Understanding Dental Insurance Networks
Understanding how your dental insurance plan works with provider networks can help you maximize the benefit, meaning less out of pocket cost for you. First, understand that there are two main types of dental insurance plans in regards to networks:
Indemnity / PPO Plans
The majority of dental insurance plans allow you to visit any dentist you wish, and plan benefits will be valid and applied. There is still a network, and if your dentist is in network, they have agreed to lower costs when you visit
HMO / Network Specific Plans
There are dental insurance plans that are network specific, meaning that you must visit a dentist in network to receive any of the dental insurance plan’s benefits. If you visit a dentist out of network, no benefits apply.
We recommend and offer Indemnity / PPO plans. It is nice to know you can continue to utilize the dentist you feel comfortable with. When recommending dental plans to customers we research and figure out which plans count your dentist as “in network” so you can take that factor into consideration. Why is it so important that your dentist is in network?
If your dentist is in network:
the dentist will file your claims for you with your dental insurer, only expecting you to pay them your portion of the cost. Out of network dentists can ask for payment in full, with you having to file dental claims and wait for reimbursement via mail.
the dentist offers you, a member of the insurance plan, lower rates (than their posted regular, retail rates) on dental services the insurance company has negotiated. These lower rates for services saves both you and the insurance company money. An example, if your dental insurance plan pays 80% of the cost of a filling, and you pay 20%, it would benefit you to pay 20% of $165, the negotiated, lower rate of a filling performed by your dentist, rather than 20% of $225, the dentist’s regular charge for a filling.
Free Dental Quote
Complete the form below and we will send you ideas of dental insurance to consider from a few insurance companies. We will compare the plans’ benefits and costs, and recommend what looks best based on your preferences.
