How does dental insurance work?

A good dental plan can help you manage your dental care costs, encourage visits to your dentist, and give you peace of mind. But how exactly does it work? Is dental insurance the same as health insurance?

Let’s take a look at what dental insurance does and how it works, as well as common terms you need to know.

Coverage 101: Understanding dental insurance

In many ways, dental insurance is a lot like regular medical insurance. You pay a set amount each month to your insurance provider, and when you go to the dentist, your plan helps cover part of the cost.

Dental insurance usually covers 100% of preventive care services, like checkups, X-rays, and cleanings. It also often includes a certain rate for basic and major procedures, such as fillings, simple extractions, root canals, crowns, and complex extractions.

When looking for a plan, it’s important to know what language insurance companies use to explain the scope and limitations of your coverage. A better understanding of your plan can help you get the most out of your care. Here are some terms you need to know.

Dental insurance is deductible

The deductible is the amount you pay for dental care before your plan begins to help with costs. Most, if not all, non-preventive dental services have a specific deductible attached to them. Once you pay that amount, your insurance kicks in and begins to cover the remaining percentage of costs. Deductibles are usually listed for each service on your plan’s summary of benefits, which is a detailed breakdown of the coverage you approve of when you sign up.

Dental co-insurance

Coinsurance is the percentage you pay for a service after your deductible has been met. Many plans cover basic, non-preventive services at 80%. In this situation, when you pay the deductible, your insurance will pay the remaining 80% of the cost of care. The remaining 20% ​​is up to you to pay as your coinsurance.

Maximum annual benefit

Your annual benefit maximum is the total amount a plan will pay for dental care during a specific benefit period – usually a calendar year. The annual maximum benefit resets each year and typically ranges from $1,000 to $2,000 per person. Unless the patient needs deep cleaning, they usually don’t meet the annual maximum.

Dental waiting time

A dental waiting period is the amount of time you have to wait before you can receive benefits for all treatments or for specific, often expensive treatments like crowns. Depending on the program, this waiting period can range from several months to a year. Most commonly, however, a routine inspection and cleaning is covered immediately.

So why is waiting time often part of the coverage? They act as protectors for the dental insurance company. They generally apply to more expensive treatments to help prevent people from seeking coverage to meet their often urgent, often urgent need for a dental, implant, or similar dental procedure.

Sometimes, the waiting period can be waived if you can demonstrate that you have continued coverage from one dental plan to the one you recently switched to.

What are the different types of dental insurance?

While there are different types of dental plans, it’s best to start your search by narrowing down where you can get dental coverage. You may be offered a dental coverage option through your employer, or you can purchase a plan for yourself – both individually and as a family.

Discount plans are also an option. With these, your insurance company will help you get a discount on the service instead of contributing to the cost of care. Also, if you qualify, you can get coverage through Medicare Advantage Plan.

Have more questions about dental insurance?

Learn about HealthPartners dental plans and which coverage best suits your needs.

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