Dental insurance can be tricky. There are many things about dental insurance that individuals may not know and this can cause major confusion and financial struggle. Understanding how dental insurance operates is essential in deciding whether or not acquiring dental insurance is the right decision for you. Listed below are some common things that you may or may not know about dental insurance.
Dental Insurance Does Not Offer Full Coverage
Unlike medical insurance, dental insurance often does not offer full coverage for dental services. The rate of coverage is usually determined by the type of service being provided. Generally speaking, preventative services usually have the highest coverage rate, followed by restorative services, and then major treatments. Some dental insurance companies will offer full or almost full coverage on preventative services. However restorative and major services are almost never covered in full and instead require individuals to pay a copay, or the amount remaining once a level of coverage has been determined. This means that even with dental insurance, you will most likely still be responsible for approximately 40-60% of the procedure cost.
Dental Insurance Has Yearly Maximums and a Yearly Deductible
Another thing that some people may not realize about dental insurance is that there are yearly maximums. This means that once you have exceeded the yearly maximum, you do not receive any further coverage. Oftentimes this yearly maximum can range from approximately $1,000-$2,500. In addition to having a yearly maximum, dental insurance plans also have a yearly deductible, which is the amount of money that must be paid into the insurance company before an individual receives coverage. This means that even if you have dental insurance, it will not actually “kick in” until the deductible is paid in full.
Pre-Authorizations Can Determine Coverage Levels
Before deciding to undergo any type of dental treatment, you can request something known as a pre-authorization. A pre-authorization allows you to get a quote on the cost of treatment from your insurance company before the actual treatment. This quote will determine exactly how much coverage the insurance company is providing so that you can determine how much your copay will be. If you are not sure about the extent of your coverage, this is a good way to avoid financial hardship from paying for dental treatment.
You Can Choose Between a Dental HMO and a Dental PPO
Similar to medical insurance, dental insurance also allows you to choose between a HMO and PPO. Dental HMOs and PPOs are structured in the same way as medical HMOs and PPOs. Dental HMOs have a sole dental provider, but extensive coverage, while Dental PPOs have a multitude of providers, but coverage levels have more variation depending on certain factors. Both plans have their own limitations as well. For example, HMOs tend to provide higher levels of coverage for more outdated procedures, while PPOs may have reduced coverage on certain doctors because they are considered “out of network”. Choosing which one is right for you depends upon your individual dental and financial needs.