Risky Business

Dental Insurance Basics

General Thoughts

There is no doubt about it, dental care is expensive. For some, the expense is a deterrent or at least a really good reason for putting it off. So although postponing going to the dentist seems like a good idea financially, there is a downside. Teeth are the only tissue in our body that do not heal themselves, it’s best to take care of our teeth acting preventatively when we can. When dental needs get ignored you put yourself at risk for larger problems often resulting in a much more costly situation.

Relying on dental insurance to lighten the financial load of seeing a dentist is a beautiful thing, but it does not pay for everything. It’s best to think of it as adjunct service or like dental coupons, it usually won’t cover all your dental expenses but it will certainly help. When looking into coverage, make sure to do your research, here are a few things you should know.

  • PPO plans allow a person to pick any dentist, in or out of that insurance company’s network. In network, dentists agrees to charge in accordance with the insurances fees schedule. Out of network, dentist charge their regular fee schedule no matter what the insurance company’s fee schedule is. The patient pays if there is a difference.
  • HMO plans allow a person to pick a dentist only from the insurance company network. The dentist is paid by the insurance company at a lower set price.
  • Most dental insurances have an annual maximum of $1000.00, which despite yearly inflation has stayed the same since the 1970s. In the 70’s crowns cost maybe a few hundred dollars, now they cost $1000.00 to $1700.00.
  • Most dental insurances pay 100% – 80% on preventative dental visits such a regular cleanings, x-rays and exams. All other procedure are covered at 80% or less leaving the patient with the balance.
  • Individual coverage is an agreement between the patient and the insurance company, usually not the dentist. Knowing your dental plan is not the office’s responsibility.
  • Most insurances go off a calendar year meaning every January any unused benefits go away and new benefits are allotted. You want to make sure you have used your benefits as needed with dental cleanings, exams and any treatment before the new year starts.
  • Dental insurance may not be worthwhile if paying out of pocket. Monthly premiums and copays can cost more than the treatment needed.
  • You are not stuck picking from a list of dentists per your insurance. You can always find a dentist you like and ask what coverage they accept before signing up for an insurance plan.

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