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What You Don’t Know About Dental Insurance

Hand with a pen filling out a dental insurance form

If you need to have dental work done, you may be entertaining the idea of purchasing dental insurance. However, it is important to understand how dental insurance works before deciding which plan to purchase. Dental insurance can be tricky, and there may be things that you do not know about dental insurance.

For starters, one very important thing to realize is that dental insurance is not like medical insurance and instead is only designed to offer partial coverage. Although certain dental insurance companies will provide full coverage for preventative treatments, most companies require some type of copay for dental services. A copay is the amount paid out of pocket and is the amount left over after the insurance company has paid their coverage.

The rate of coverage an insurance company will offer often depends on the type of service being provided. As mentioned before, some dental insurance companies will provide full or almost full coverage for preventative services. However, restorative services and major treatments are oftentimes never covered in full and can require a copay ranging from approximately 40-60% of the cost of the procedure, depending on the insurance company.

Coverage can also depend on the type of dental insurance plan you have. Dental insurance can be either a DHMO or a DPPO. With a DHMO, individuals pay a monthly fee to the insurance company and select a single dental provider for all their dental needs. In return for using only one provider, the insurance company will usually provide extensive coverage. However, this coverage is usually for more outdated treatments.

DPPOs, on the other hand, also require a monthly fee be paid to the insurance company, however they offer a range of dental providers, although coverage rates have more variation than those of an DHMO. PPOs offer more flexibility in terms of providers, however their coverage rates are much more unpredictable since some providers can be considered “out of network”.

Another important thing to realize about dental insurance is that it requires the yearly deductible be paid in full before coverage starts. This means that you cannot simply purchase a dental insurance plan and expect treatment coverage right away. If you are planning to have dental work done and you want to have dental insurance, you need to make sure to purchase a plan well in advance to make sure your deductible is paid and you have coverage for the procedure.

Once the deductible is paid, it is also important to note that most dental insurance companies have a yearly maximum. This refers to the total amount that an insurance company will pay per year. Generally speaking, this amount is somewhere in the range of $1,000-$2,500. Once this amount has been reached, the insurance company will pay nothing more, and the remainder of the expenses will need to be paid out of pocket.

Finally, if you have or will be getting dental insurance and you are not certain about the level of coverage offered, you can request something called a pre-authorization. Pre-authorizations are submitted by your dental office to your insurance company and will determine how much the insurance company intends to cover for the cost of the procedure. This is extremely helpful to avoid financial struggle after a dental treatment.