Paying the dentist is a big deal for many families. Dental insurance can be a great option to ensure that you and your family always have access to the dental care you need.
With the rising cost of dental visits, many people find it difficult to decide whether or not to purchase dental insurance. Whether you are considering dental insurance through your employer or independently, be sure to investigate several different plans and ask about several factors, including network policies and types of coverage. . This information will help you choose the right dental insurance plan before you sign on the dotted line.
Affordability and annual maximum
The annual maximum is the highest amount the dental insurance plan will pay in a full year. The annual maximum will be automatically renewed each year. If you have any unused benefits, these will not carry over. Most dental insurance companies allow an annual maximum of $1,000 to $1,500.
Dentists entering/leaving the network
Most independent dental insurance plans will only pay for your dental services if you go to a contracted, network-participating dentist. Find out if you have to go to a participating dentist or if you can choose your own. If the plan requires you to see an in-network dentist, ask for a list of dentists in your area that they have contracts with so you can decide if they have a dentist you are considering seeing.
If you want to stay with your current dentist, some policies allow you to see an out-of-network dentist, however, the covered costs can be significantly reduced.
UCR (Usual Customary and Reasonable)
Almost all dental insurance companies use what is called a Usual, Customary and Reasonable (UCR) rate guide. This means that they set their own price that they will authorize for each dental procedure they cover. It’s not based on what a dentist actually charges, but what the dental insurance company wants to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee they set.
If you have a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contract dentist usually has an agreement with the insurance company to write off the difference in fees. If the policy allows you to go to a dentist or pediatric dentist of your choice, check the insurance company’s UCR fee guide against the fees charged by the dentist. You may have to pay the difference out of pocket, but you can’t put a price tag on quality dental care.
Types of coverage
According to most dental insurance companies, dental procedures are divided into three categories:
- Preventive: Most insurance companies consider routine cleanings and exams preventive dental care, however, X-rays, sealants and fluoride may be considered preventive or basic, depending on the specific insurance company.
- Basic or restorative: Basic or restorative dental treatment usually consists of simple dental fillings and extractions. Some insurance companies consider root canals basic, while others classify them as major.
- Major: Crowns, bridges, dentures, partials, surgical extractions, and dental implants are dental procedures that most dental insurance companies consider a major procedure.
Since all dental insurers are different, it is important to clarify which dental procedures fall under each specific category. This is important because some insurance plans do not cover major procedures and others provide waiting periods for certain procedures. If you know you’ll need major dental work that isn’t covered by a particular plan, you should probably look elsewhere to find one that meets all of your needs.
A waiting period is the amount of time an insurance company will make you wait after you are covered before paying for certain procedures. For example, if you need a crown and the policy has a waiting period of 12 months or more, chances are you’ve already paid for your crown while you’re paying your premiums and waiting.
Missing tooth clause and replacement period
Many dental insurance policies include a “missing tooth clause” and/or a “replacement clause”.
A missing tooth clause protects the insurance company from paying to replace a missing tooth before the policy takes effect. For example, if you lose a tooth before your coverage begins and decide later that you want a partial denture, bridge or implant, the insurance company will not have to pay for this service if they have a missing tooth clause in the plan. .
A replacement clause is similar, except the insurance company will not pay to replace procedures such as dentures, partials, or bridgework until a specified time has passed.
Cosmetic dentistry and dental insurance
Cosmetic dentistry is any type of procedure performed solely for vanity purposes. Teeth whitening is very popular. Although the effects are magnificent, keep in mind that the vast majority of dental insurance companies will not pay for cosmetic dentistry.
Before deciding to purchase dental insurance, discuss the scope of your treatment plan with your dentist. This way you can decide if you would be better off with or without dental insurance. A very important factor to remember about any dental insurance plan is that dental insurance is not at all similar to medical insurance. The majority of dental insurance plans are designed to cover only basic dental care for around $1,000 to $1,500 (about the same amount they covered 30 years ago) per year and are not intended to provide comprehensive coverage like that of medical insurance.
A word from Verywell
To help fund your dental care, many dental practices now offer interest-free payment plans because they understand that dental insurance only pays a small portion. Remember that dental insurance is very different from medical insurance, and be sure to discuss the best option for you with your dentist before embarking on any new treatment plans.