A lot of Americans out there have dental benefits. 77% according to the National Association of Dental Plans. Most of the time, this is private coverage from an employer or group program. However, many people don’t fully understand what their plan covers. You know that your regular checkups are covered, but what if you’re dealing with a dental emergency and need attention from your dentist? How much with you be responsible for? Continue reading to learn more about dental insurance and what exactly it covers.
What Types of Dental Insurance Plans Are There?
There are a few different types of plans out there when it comes to dental insurance. You will generally have the following options:
- Preferred Provider Organization (PPO): This gives you the option between choosing from a list of dentists that accept the plan or choosing your own dental provider. If you go to one that is out of network, your out-of-pocket costs will be higher.
- Dental Health Maintenance Organization (DHMO): These plans provide a network of dentists that accept the plan for a set co-pay, or no fee at all. But you may not be able to see a dentist who is out of network.
- Discount Dental Plan: This is a plan where you get a discount on dental services from a select group of dentists, but the plan doesn’t cover any of your care. Instead, the participating dentist gives you a discount.
What Does My Dental Insurance Plan Cover?
Every plan is different, so your insurance benefits could differ from others. Sometimes, dental plans may elect not to cover certain procedures. But generally, they cover a 100-80-50 coverage structure. This means that they cover:
- 100% of preventive care: This includes checkups, cleanings, and routine x-rays.
- 80% of basic procedures: Basic services include fillings and periodontal scaling.
- 50% of major procedures: This includes more complex services like dental implants, dentures, and orthodontic treatment.
Every plan out there has a cap on what it will pay during a given year. This is your annual maximum. After you reach this amount, you are responsible for all expenses. If you have numerous dental needs in one year, you could reach that maximum fairly quickly. To know exactly what your plan covers, you will have to read your dental policy closely.
Will My Dental Emergency Care Be Covered?
The answer to this question varies greatly. It depends on the type of emergency you have and the treatment you require in order to restore your oral health. For instance, if you require a filling, 80% of the cost would generally be covered. If you require a more complex dental procedure, they may only cover half of it. However, the longer you put off a dental issue, the worse it will get. Chances are that you will need to pay more later then if you have the problem dealt with now.
If you’re worried about whether or not your benefits will help you in your situation, you can always talk to your dental team. They will be able to help you figure out what you will be responsible for and can let you know about other payment options they have available. Getting essential dental care shouldn’t mean breaking the bank.
About the Author
Dr. Art Mowery is an experienced dentist whose career in the field spans more than two decades. He earned his DMD from the University of Florida College of Dentistry and is a member of several professional organizations including the Florida Dental Association. If you’re dealing with a dental emergency, Dr. Mowry would be happy to help. For more information on dental insurance or to schedule an appointment, visit his website or call (352) 332-6725.
