Do you have questions about dental insurance and what it covers? Why do you want this type of insurance? What is the difference between the different types of insurance? Clearly, the idea is that insurance can help you lower your costs for dental care compared to not having any coverage at all. With insurance, you pay a monthly premium, possible through your work or as a stand-alone policy. But then the confusing questions start. What dental care is covered and what is not covered? How do you know what is the best option for you and your family? Hopefully, we can clear up some of the confusion for you.
Your medical insurance plan usually has a deductible. For Example, if your deductible is $2,000, once you reach that out-of-pocket expense, your insurance plan pays 100% of the procedures (in-plan) for the rest of that year. Whereas, your dental insurance usually works in the opposite manner.
Most dental insurance plans have annual maximums. These are not deductibles. Although, some may also have deductibles too. More confused?
How Maximums Work with Your Dental Insurance?
Example: Your maximum per year is $2,000. Once you have reached $2,000 in dental expenses that your insurance company has paid, you are now responsible for 100 percent of your dental care costs for the remainder of that year.
Tiered System of Coverage
Most dental insurance plans have a tiered system. This system definitely gives you the incentive to get regular preventative dental care.
What is a Tiered System?
Usually, the insurance will cover 100%
- Your yearly exam (some plans cover every 6 months)
- Annual cleaning
- Bitewing x-rays
In addition, they usually cover fillings, full mouth x-rays, and periodontal maintenance by 80% and major dental care at 50%. The list may be slightly different for each dental insurance plan but in general, that’s the way most of them work.
That’s great, right? Because most dental diseases can be prevented with regular visits and proper oral care.
But what happens with emergency care?
Through no fault of your own, you end up needing a root canal and crown. Most insurance plans will cover 50% of those costs. But once the yearly maximum has been met, you have to cover the rest. However, if you have a Full Coverage Dental Plan, they will cover more.
What is Full Coverage Dental Insurance?
Full coverage dental insurance will cost you more in monthly premiums but it will cover more as well. Typically these are the types of things that will be covered.
- Orthodontic care
- Basic restorative care such as fillings, extractions, specialty x-rays
- Major restorative care such as crowns, bridges, dentures
What do the initial DHMO and DPPO stand for?
DHMO stands for Dental Health Maintenance Organization
DPPO stands for Dental Preferred Provider Organization
What is the difference between a DHMO and DPPO?
The main difference between the two types of dental insurance for you is cost and flexibility.
Most DPPO plans offer flexibility at a higher cost.
DPPO
- Most have yearly maximums
- Most have yearly deductibles
- Coinsurance may kick in after you’ve met yearly deductibles
- You can see any dentist in you want but you will pay less if that dentist is in the plan’s network
- Primary Dentist – You are not required to pick one or need a referral to see a specialist. But again, you will save money if you do use one in the plan’s network.
Most DHMO plans are designed to keep your dental costs lower and have less flexibility.
DHMO
- May not have a yearly maximum
- Most do not have yearly deductibles
- Coinsurance requires you to pay % of costs based on a flat rate for each service and you typically do not have to meet a yearly deductible
- You are required to see a dentist in a network in order to be covered
- Primary dentist – you will have to pick one. They will refer you to a specialist as needed.
Before you enroll in any dental plan, make sure to read the details of your plan coverage, including limitations, exclusions, and possible waiting periods.
What Insurance do we take at Mid Cities Dental?
At Mid Cities Dental, we do not take DHMOs due to their restrictions. Our office is considered in-network with most insurance companies but not all of them. Our standard fees are considered usual and customary by the insurance companies. Therefore, our fees are similar to in-network fees. Here is a link to our page listing the insurance companies we work with. Please contact our knowledgeable staff with any questions concerning your dental insurance coverage.
SOURCES:
ADA: Types of Dental Plans
Mouth Healthy: Dental Benefits: Paying for Dental Care
Your insurance company may have a benefit deadline of December 31.
Therefore, you may need to use up your dental plan benefits before then as they will not roll over into the New Year.
Still, some plans may end at different times of the year.
Check your plan to be sure.