Dental insurance policies help many people effectively budget for the cost of maintaining a great smile. Compared to medical insurance, understanding dental insurance policies is a great idea. Most policies are simple and specific about what procedures are covered and exactly how much you have to pay out of pocket. Dental insurance is available as part of health insurance plans or as a stand-alone policy.
key takeaways
- Dental insurance covers problems related to teeth and gums, as well as preventive care like annual cleanings.
- Not all procedures are covered; for example, there are no cosmetic procedures such as crowning or whitening.
- Deductions, copays, and cash guarantee will apply, and many policies have relatively low maximum annual coverage limits, in some cases between $750 and $2,000.
System Overview
First, here’s a breakdown of how private dental insurance works. You choose a plan based on which providers (dentists) you want to be able to choose from and how much you can afford to pay.
- If you already have a dentist that you like, and is in the network of insurance companies, you can choose one of the cheapest plans.
- If you don’t have a dentist, you can choose network dentists and choose again for a more affordable plan.
- If your current dentist isn’t in the network, you can still get insurance, but you’ll pay much more to see your dentist than an in-network dentist; much more that you will have no chance of finding the next one by being insured.
Monthly premiums will depend on the insurance company, your location, and the plan you choose. For many people, the monthly premium will be around $50 per month. This means you’re spending $600 on dental expenses each year, even if you can’t find a job.
Waiting period for dental insurance
Most dental insurance policies have waiting periods of six to 12 months before any standard work can be done. Waiting times for major works are often longer and can be up to two years. Insurance companies set these periods to guarantee earnings from a new account and to discourage people from applying for a new policy to cover upcoming procedures.
Deductibles, copayments, and coinsurance
The insurance deductible is the minimum that must be paid before the insurance policy pays anything. For example, if the deductible is $200 and the covered person’s procedure is $179, the insurance does not start and the person pays the full amount. Copays, amounting to a fixed dollar, may be required at the time of the procedure.
When a dentist deductible is met, most policies only cover a percentage of the remaining costs. The remainder of the bill paid by the patient is called the cash balance, which is typically between 20% and 80% of the total bill.
Most dental insurance plans follow the 100-80-50 payment structure: they pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.
How dental insurance categorizes and pays for procedures
Dental procedures covered by insurance policies are generally grouped into three categories of coverage: preventive, basic, and major. Most dental plans cover 100% of preventive care, such as annual or semi-annual office visits for cleanings, x-rays, and sealings.
Dental insurance policies help many people effectively budget for the cost of maintaining a great smile. Compared to medical insurance, understanding dental insurance policies is a great idea. Most policies are simple and specific about what procedures are covered and exactly how much you have to pay out of pocket. Dental insurance is available as part of health insurance plans or as a stand-alone policy.
key takeaways
- Dental insurance covers problems related to teeth and gums, as well as preventive care like annual cleanings.
- Not all procedures are covered; for example, there are no cosmetic procedures such as crowning or whitening.
- Deductions, copays, and cash guarantee will apply, and many policies have relatively low maximum annual coverage limits, in some cases between $750 and $2,000.
System Overview
First, here’s a breakdown of how private dental insurance works. You choose a plan based on which providers (dentists) you want to be able to choose from and how much you can afford to pay.
- If you already have a dentist that you like, and is in the network of insurance companies, you can choose one of the cheapest plans.
- If you don’t have a dentist, you can choose network dentists and choose again for a more affordable plan.
- If your current dentist isn’t in the network, you can still get insurance, but you’ll pay much more to see your dentist than an in-network dentist; much more that you will have no chance of finding the next one by being insured.
Monthly premiums will depend on the insurance company, your location, and the plan you choose. For many people, the monthly premium will be around $50 per month. This means you’re spending $600 on dental expenses each year, even if you can’t find a job.
Waiting period for dental insurance
Most dental insurance policies have waiting periods of six to 12 months before any standard work can be done. Waiting times for major works are often longer and can be up to two years. Insurance companies set these periods to guarantee earnings from a new account and to discourage people from applying for a new policy to cover upcoming procedures.
Deductibles, copayments, and coinsurance
The insurance deductible is the minimum that must be paid before the insurance policy pays anything. For example, if the deductible is $200 and the covered person’s procedure is $179, the insurance does not start and the person pays the full amount. Copays, amounting to a fixed dollar, may be required at the time of the procedure.
When a dentist deductible is met, most policies only cover a percentage of the remaining costs. The remainder of the bill paid by the patient is called the cash balance, which is typically between 20% and 80% of the total bill.
Most dental insurance plans follow the 100-80-50 payment structure: they pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.
How dental insurance categorizes and pays for procedures
Dental procedures covered by insurance policies are generally grouped into three categories of coverage: preventive, basic, and major. Most dental plans cover 100% of preventive care, such as annual or semi-annual office visits for cleanings, x-rays, and sealings.
The basic procedures are treatment of gum disease, extraction, filling, and root canal, with deductions, copays, and posting of cash in the patient’s pocket. Most policies cover 80% of these procedures and patients pay the rest. Major procedures like crowns, bridges, inlays, and dentures are typically only covered at 50%, with the patient paying more out-of-pocket than other procedures.
Policies in which procedures are classified as preventive, basic, and major all differ, so it’s important to understand what’s covered when comparing policies. Some policies classify root canals as key procedures, while others treat them as core procedures and cover much more of the cost.
Dental insurance does not cover cosmetic procedures.
Most dental insurance policies do not cover the costs of cosmetic procedures such as whitening, contouring, veneers, and gum contouring. Because these procedures are intended to improve the appearance of your teeth, they are not considered medically necessary and must be paid for in full by the patient.Some policies cover braces, but they usually have to pay a special rider and/or postpone braces for a long waiting period.
annual maximum coverage
While most health insurance policies have annual out-of-pocket maximums, most dental policies limit annual coverage. Maximum coverage limits typically range from $1,000 to $2,000 per year. In general, the higher the monthly premium, the higher the annual maximum.Once the annual maximum is reached, patients must pay 100% of the remaining dental procedures. Many insurance companies offer policies that carry part of the annual maximum not used until the next year.
Implementation of tax credits for dental insurance
Any remaining tax credit not used to pay for family health insurance purchased through Healthcare.gov may be applied to pediatric dental insurance premiums if your health insurance policy does not include dental coverage.If your health insurance policy covers children’s dental coverage, you cannot use tax credits to purchase an additional plan.