Dental insurance is a form of health insurance that covers a portion of the cost of routine dental care. It typically includes a monthly premium and a yearly deductible.
There are many types of dental plans available. The type of plan you choose depends on your preferences and budget. Some plans require you to use a specific dentist or network, while others offer more flexibility.
Preventive care
Many dental plans cover preventive services such as oral evaluations, teeth cleaning, fluoride treatments, and annual X-rays. These services keep your teeth healthy and are essential for maintaining good overall health.
Most insurance plans also pay a small portion of the cost for Basic restorative services such as fillings and tooth extractions. The coverage may be subject to a waiting period and a deductible, as well as limits on the number of procedures you can have done each year.
These limits are based on contract negotiations between the plan purchaser and the third-party payer, and may not accurately reflect the fees charged by area dentists. Those who prefer a specific dentist should look for a DPPO, or a dental exclusive provider organization plan with a large network of providers.
Routine checkups
Dental insurance covers the cost of routine preventive procedures like cleanings, X-rays and sealants. It also pays a percentage of the cost of major restorative services such as fillings, crowns and root canals. The specific services covered by a dental plan vary by plan. Most dental plans have a monthly premium and a yearly maximum benefit.
Some plans have a low – or even $0 – out-of-pocket costs for cleanings, X-rays and dental sealants from in-network providers. But you should carefully review the details of any dental plan before enrolling, especially if it will cover major procedures, as they may require a deductible or coinsurance. Many dental plans have annual maximum benefits that reset each year, while others have a waiting period for certain services or have low annual maximum benefits.
X-rays
X-rays are a type of electromagnetic radiation that can pass through your body. They create a picture of the inside of your body by passing through different parts at different rates. Bones absorb more X-rays than skin, so they appear dark on the X-ray image while soft tissues like flesh and muscle appear lighter.
Your healthcare provider puts an X-ray sensitive film on your body and then fires a stream of X-rays through you. A detector on the other side of the body picks up the X-rays and turns them into an image.
Your health insurance plan may require a waiting period for basic services like cleanings and checkups and certain major procedures like tooth extractions or fillings. These waiting periods help keep your costs low and encourage routine care, which can catch problems early and prevent more costly treatments later on.
Fillings
Dental insurance typically covers fillings at 80 percent after you pay the deductible and copay, which can vary from plan to plan. This is because fillings are considered basic procedures, and they’re usually cheaper for insurers than more expensive procedures like crowns.
Experts recommend that adults visit the dentist at least twice a year for preventive services. Some dental insurance plans support this recommendation, while others only cover preventive visits once or twice per calendar year, or even every other year.
Some dental insurance policies also include an annual maximum, which is the amount the plan will pay for a particular procedure over the course of one policy year. Often, the maximum is less than $1,500. This means that you’ll be responsible for all costs incurred beyond this limit.
Crowns
Crowns are a common restorative dental procedure that can help repair a cracked or broken tooth. They are also a common cosmetic treatment that can improve the appearance of your smile.
While dental insurance usually covers crowns, it is important to note that the procedure isn’t covered by all plans. In fact, many plans only cover the cost of a crown at half of its total price. This means you will be liable for paying the other half.
To avoid these expensive costs, it is vital to choose the best dental plan for your needs. Look for a plan that offers clear and transparent documentation and processing guidelines to reduce misunderstandings about coverage and payment. It also should have reasonable annual maximums and waiting periods before covering major services like crowns.
Root canals
A root canal is a dental procedure that repairs and saves a tooth when it’s infected or damaged. It involves drilling into the tooth and removing the tooth pulp, which contains nerves and blood vessels. The tooth is then cleaned and sealed. The cost of a root canal can be expensive, but many dentists offer payment plans and pricing that fits into most budgets.
Dental insurance can cover a portion of the cost of a root canal. Patients should be sure to check their coverage carefully before getting the treatment. Keeping up-to-date codes, detailed documentation, and prompt billing can help reduce errors and streamline the reimbursement process. Some dental insurers also have annual maximums, so patients should consider this when choosing an insurance plan.
Implants
Dental implants are used to replace missing teeth. They can help prevent bone loss and provide a more attractive appearance than dentures. They are also stronger than natural teeth and are less likely to shift over time.
Implants can be covered by a dental insurance plan. There are two main types of dental insurance: indemnity plans that pay a fixed amount regardless of which dentist you visit and managed care (DHMO and PPO) plans, which limit your choice of dentists and may include a deductible and annual coverage limits.
The success of a dental implant depends on the patient’s commitment to good oral hygiene, regular visits and maintenance care. Heavy smokers, patients with uncontrolled chronic conditions such as diabetes or heart disease and those who have had radiation therapy to the head/neck area are at higher risk for implant failure.