Understanding Dental Insurance

When you’re job hunting, there’s a lot of different factors you might look into to pick the best spot. You might check out the people at the job, hoping to form meaningful, lasting relationships. You might look at the salary, to make sure you’ll be paid what you’re worth. You might look at growth opportunities, to be certain you’ll be able to develop your skills and move up in the world. More and more, you might also look into what benefits package the prospective employer provides; insurance for vision, pharmaceuticals, and dentistry. For those who aren’t well versed in insurance, it’s not always obvious what this insurance can do for you, so let’s break down an average dental insurance contract.

Most dental coverage will be broken down into categories: basic dental care, major dental work, and orthodontics (occasionally, the last two are grouped together). Basic dental care includes much of what you’d expect from a dental visit; the exam fee, the cleaning, fillings for cavities, x-rays, and other standard work; root canals are often covered under this schema. Major dental work includes crowns and bridges, while orthodontics include braces and retainers. These categories often have what are known as co-payments; that is to say, the insurer will not cover the full amounts. Co-payments for basic dental care are often 80/20 (the insurer pays 80, you pay 20), while major and orthodontic work is often covered at 50/50.

There can be deductibles on your plan; these might be paid once a year or once per procedure; it’s rare to see them for dental work, but you might see them a bit more often for major or orthodontic work. Deductibles, are, in the simplest terms, an amount that you must pay before the insurer pays out; they are generally applied before the co-payment. Let’s say you have a $50 annual deductible, and your dental bill for basic work comes out to $250; you’d pay the 50$ deductible, then the insurer would pay 80% of $200 ($160); you’d pay $90 for your $250 dental bill. Should you have another bill to pay later in the year, you would not have to pay the deductible again.

Some contracts have limits to the amounts payable for your dental care; these limits usually apply to major and orthodontic work. Limits are simple enough; when they are reached, the insurer won’t pay out any more. These limits can be yearly, or they might be lifetime limits. It’s important to understand that the limits aren’t on claimed amounts, but on paid amounts; if you have a limit of $1000 and you submit a $1000 bill that gets paid at 50%, you’ll only have taken $500 out of your $1000 limit.

Claiming your insurance will vary from provider to provider – by that, I mean insurance provider and dental provider. Different dentists and different insurance companies will accept direct pay (sometimes called direct billing); that is to say, there’s an arrangement between the dentist and the insurer by which the dentist can bill the insurer directly, so you don’t have to pay up front.  You should check with your dentist to make sure they accept direct pay to your insurer.

The most important thing to understand about insurance contracts is that they are all different; the time frames for the limits, the co-payments, the eligible procedures, and the deductibles can all vary significantly. We’re proud to have experienced dentists who can help you understand your dental insurance contract; if you have questions, we can help.