Dental insurance is almost a must-have in today’s society. With the rising cost of dental care, having dental insurance will help you financially. Many people find that their employer will offer dental insurance. There are several types of dental insurance including: HMO, PPO and indemnity plans. Dental insurance is similar to health insurance in the way it is structured.

Most dental insurance plans will cover approximately $1,000-$1,500 of dental services each year. For people who have a couple cleanings and a few small cavities, this is a perfect amount. However, if you are prone to bad teeth that wind up in large cavities, root canals, and crowns you better be prepared to pay out of pocket expenses.

If your employer doesn’t offer dental insurance, you may be able to buy an individual plan. Many insurance companies can deny you coverage if you have made a large number of claims in the past. Keep in mind that the premiums for individual dental insurance can be quite expensive.

Some smaller insurance companies offer a discount dental plan. If you elect to go to an in-network dentist you will have discounted rates. The catch is there is a monthly or annual fee involved as well. Before you select coverage from an independent dental insurance company, you should check with your dentist to make sure they accept this insurance. Many dentists will no longer accept patients who are on Medicaid or PCN, as they do not receive as much money for the services they provide. Many dentists are willing to set up an in-house account to work with your finances. Some dentists can even refer you to an insurance company or network that will help pay for expensive dental costs.

Before you select a dental insurance plan, you should ask yourself a few key questions:

1. Can I choose my own dentist? If you have a close friend or relative who is a dentist, you probably want to go to them. Since most dental insurance plans only allow you to go to in-network dentists, you may decide it is worth the extra money to go to a dentist of your choice.
2. Can I select my treatment? If your dentist has recommended a certain procedure, check to see if your insurance company covers it. Many insurance companies will not pay as much money for a root canal that is done by an endodontist. Be sure you are getting the best treatment options for the price your insurance company is willing to pay.
3. What is covered? Most dental insurance plans will pay 100% for preventative care procedures such as check-ups, cleanings, and fluoride treatments. After this, the cost is usually split 50/50.

1. What will I pay? If your employer is sponsoring the dental insurance plan, you can’t go wrong with the small premium cost you are paying. If you elect to choose dental insurance on your own, you will find that you have a much higher monthly premium amount.

To gain a better understanding of dental insurance, let’s look at a few key terms you need to be aware of:

Yearly Maximum
The yearly maximum is the designated amount your dental insurance plan will pay within one full year. Again, this amount is typically around $1,000 to $1,500. Unlike some health insurance policies, if you have unused benefits, they will not roll over.

In/Out of Network Dentists

Most dental insurance plans will pay only if you go to an in-network dentist. The in-network dentists have agreed to accept payment amounts set by the dental insurance company.

Your insurance company should provide you with a listing of in-network dentists. If you choose to stay with an out-of-network dentist, some insurance plans will pay a small portion of the cost.

You can always contact your dentist’s office directly and ask what type of insurance they accept.

Usual Customary and Reasonable (UCR) Fee Guide

Dental insurance companies have established a set price for every dental procedure they cover. The dentist may charge more for a certain procedure, but your insurance company will only pay what their UCR guide states.

If your policy requires you to go to an in-network provider, you will not be charged the difference between the dentist’s price and the UCR price. Typically, the contracted dentist and the insurance company write off the difference in charges. If your insurance allows you to pick your own dentist, you may need to check the UCR guide against the dentists charges to make sure you have enough money to cover the out-of-pocket expenses.

Dental Insurance Coverage Types
Most dental insurance companies break procedures down into 3 types: preventative, basic or restorative, and major.

Preventative dental procedures are considered to be routine cleanings, x-rays, sealants, fluoride, and any preventative dental care. Typically, these costs are covered at 100 %.

Basic or restorative dental procedures are described as fillings for cavities or simple extractions. Root canals are also considered basic procedures. Most dental insurance companies will pay 50% for basic or restorative dental procedures.

Major dental procedures are considered to be crowns, bridges, dentures, partials, surgical extractions, and dental implants. Many insurance companies only offer to pay 25% to 40% of these costs.

Before you select a dental insurance provider, you should find out what procedures fall under which of the above categories. It is estimated that the average cost of a root canal is approximately $800 - $1,500. If your insurance company will pay at least $400 towards the cost of the root canal, you need to come up with the difference. Don’t forget that a tooth that has had a root canal will also need a crown and you may need to pay the entire cost of that crown. A crown can cost between $400 to $800 dollars.

Dental Insurance Waiting Periods

Once you have been enrolled in a dental insurance plan, you may have a waiting period for certain procedures. Many dental insurance companies make you wait 30-90 days for basic treatment procedures and upwards of 12 months for major treatments such as crown. If you know you are in need of a root canal and crown, you may find that you can already pay for this procedure out-of-pocket while you have been paying your premiums and waiting for coverage to begin.

Missing Tooth Clause and Tooth Replacement Period
A missing tooth clause protects the insurance company from paying for a missing tooth before the policy was in effect. This means if you lost a tooth prior to having dental insurance and decided later on that you would like to have a partial, bridge, or implant, the insurance company will not have to pay for that procedure. More than 90% of dental insurance policies carry this clause.

The tooth replacement clause is similar to the missing tooth clause. It states that the insurance company will not pay to replace dentures, partials, or bridges until a specified time limit has passed.

Be sure to know if your dental insurance company has this clause before you decide to have a procedure done. Many dentists are not aware of the exact details of all the insurance companies and may recommend a procedure that is not covered.

Cosmetic Dentistry
Teeth whitening and veneers are considered to be cosmetic dentistry. Cosmetic dentistry is classified as a procedure done for “vanity purposes only”. This means that most insurance companies will not pay for cosmetic dentistry procedures.

Many dentists now offer a free teeth whitening for new patients. If you feel you would like a free teeth whitening, you will need to sign up for at least one check-up and cleaning before you can indulge in your “vanity procedure”!

Comprehensive Coverage
Remember that dental insurance is not like health insurance. It only covers up to a certain amount. Speak with your dentist about the extent of your treatment plan. Remember that dental insurance does not provide comprehensive coverage like your medical insurance coverage does.

Pre-Payment Insurance
Many dentists are now creating their own in-house dental insurance plans. Each month you make a designated amount to your dentist in exchange for interest-free payment plans. This is not like typical dental insurance coverage from an insurance provider; it is strictly an in-house contract with your dentist.

The best option you have available is to sign-up for dental insurance through your employer. Employers are given excellent dental plans because they have a large number of employees who sign up for coverage. This means your employer will pay a large portion of the premium, leaving you will a small amount to pay. Most companies will only make their employees pay around $25.00 or under for family dental insurance plans. Keep in mind, that the more family members you add to your dental insurance, the more you will have to pay toward the premium.

All in all, investing in dental insurance is a smart choice. If your employer is willing to cover most of the premium, you should sign up today. Even if you only go in for 2 cleanings a year, you are still saving yourself money on the exam, cleaning, x-rays, and other charges that could be applied.