Dental Insurance

The purpose of dental insurance is to help alleviate the costs associated with necessary routine dental care. Many Americans don't seek essential dental treatment due to the thought of out-of-pocket expenses. Dental treatments today vary in price anywhere from $300 per year for regular dental hygiene visits, up to $25,000 or more for restorative procedures or cosmetic dentistry. Unfortunately, compared to medical insurance coverage, dental insurance plans typically offer fewer benefits.

Dental insurance plans in the United States are specifically designed to help covered individuals receive necessary, routine dental care. Certain plans restrict the number of dental visits, X-rays and treatments that are covered, and other services may not be included. Some plans reimburse patients only when the least expensive treatment option is selected, while others provide no coverage for essential treatments.

Dental Insurance Plan Types

There are several types of dental coverage plans.

Indemnity plans allow you to select your own dentist, and these plans are considered fee-for-service. They come with restrictions and co-payment options, meaning that only a flat rate for a dental visit is paid, and there is an annual limit on coverage for dental spending. Specific coverage restrictions may only apply to individual dental procedures, but the patient may elect to pay out of pocket for whatever procedures he or she wants (hence, fee for service).

Self insurance dental plans are similar in nature to indemnity plans, but may prohibit participants from selecting the dentist of their choice. Closed panel insurance plans restrict you to seeing a specific group of facilities and the number of dentists available to you. Capitation dental plans assign particular dentists for treatment, and these dentists are under contract. They will be paid a fee regardless of whether treatment is required or not.

Preferred Provider Organization (PPO) insurance plans are restricted to a group of dentists who provide dental care at a reduced fee. Direct reimbursement plans enable employers to directly reimburse their employees for dental services they receive. Dental care service plans use a group of dentists who form a non-profit organization to provide dental care at set rates.

Using Your Insurance and Paying For Treatment

If you have dental insurance, become familiar with the plan so you know what treatments are covered and how said coverage works.

For instance, if a dental filling is needed but you prefer a composite material, it would be best to evaluate the benefits included in your plan for composite fillings. Most insurance companies only reimburse the cost for composite fillings at a rate equivalent to that of an amalgam (silver-looking) filling. As a result, the remaining balance would be paid out-of-pocket. The same can be said for braces patients that want an alternative orthodontic approach such as Invisalign or ClearCorrect.

Dental Insurance and Cosmetic Dentistry

Dental insurance companies usually don't cover cosmetic dentistry procedures. If you have insurance and veneers (or Lumineers) are required for restorative purposes, talk to your dentist about filing for reimbursement for a percentage of the costs. If you're undergoing a smile makeover that requires multiple hygiene or therapeutic treatments as prerequisites, such as root canals or bite adjustments (perhaps related to TMJ), some of those costs might be insured.

Before you agree to and receive any treatment, find out from your dentist what your treatments will cost. Dental insurance plans vary in the level of reimbursement they provide for certain procedures and in annual dental spending limits. Some plans establish a limited waiting period before certain dental treatments can be provided. Also, most plans have exclusions, suggesting that costs for particular dental procedures will not be reimbursed. Dental office finance managers can talk to insurance providers to determine the out-of-pocket costs associated with planned procedures.