Like most health plans, the purpose of getting a dental insurance plan is so that you have enough money set aside when dental procedures need to be done. It’s a fact that the cost of dental work is rather expensive and rates vary with each professional. A simple filling, for example, can go for $120-150, and the expense may not be something you’re ready to pay for. Holding off getting a filling because of budget constraints could have huge consequences.
A dental insurance plan is usually given to employees as part of their work benefit. The coverage includes preventive procedures, such as when you need to get a cleaning, or do consultations, or require an x-ray. Other procedures, like getting a filling or a root canal, may only require you to pay 20% outright, while the rest of the expenses are handled by the insurance.
If a company, however, can’t include dental insurance to your employee benefit, you can privately purchase one, or upgrade to another coverage provided at work, especially if you think that you could use more. What type of dental insurance plan is best actually depends on what you need from it.
What’s in A Dental Plan Coverage?
- Preventative. This covers cleanings and examinations that ensure your teeth are free from cavity and other dental problems. Depending on the insurer, some coverage may also include fluoride applications and x-ray procedures to this coverage. The insurance company pays 100% of the treatment, while the premium for this coverage may cost around $15-50 a month.
- Restorative. Fillings, extractions and root canals (for some insurers) fall under the basic plan. Coverage for this may mean that insurer will shoulder 80% of the total expense, as you pay $25-50 for the monthly premium.
- Major. Surgical procedures, crowns, dentures and implants fall under major coverage and the premium, of course, costs more.
There is usually a waiting period with insurance companies, in that they will still have to assess if a procedure you got can be covered. Sometimes the wait can take over a year, which means that as you’ve been paying for the premium for your dental insurance, you may have already proceeded with the treatment and paid in full out of your own pocket. If the insurer approves this after their assessment, you will then be reimbursed for the amount you paid for.
Additionally, coverage may include caps or limits. Some dental insurance plans may only agree to cover $1000 of the cost of procedures in a given year, which means that if you need successive dental work that could take months to complete, and the cost exceeds $1000, the insurer will not pay for the excess anymore.
Forms of Coverage
Dental plans can either be taken under an HMO organization, a preferred provider, or through an indemnity plan.
- HMO’s cover 100% of a basic preventive or restorative treatment, usually. But the HMO may require a bigger premium cost for other complicated procedures, and you can only get treatment from dentists they endorse.
- A preferred provider means that the insurance coverage allows you to avail of the service of a dentist of your choice, but they may only cover 50% to 80% of the procedure.
- The indemnity plan seeks higher premium payments, and may be better applied for group plans. You can also get treatment from any dentist you want and the insurer will cover the procedure.
Braces Insurance Coverage?
Most dental insurance coverage do not include getting dental braces, as it is a considered a cosmetic procedure. Finding an insurer can be tough, but there are orthodontists that work hand in hand with insurance companies to make payment for braces easier. Sometimes, a dental insurance may be approved, only if the braces treatment needed is to correct a severe dental problem. For example, a patient may have a severe underbite that limits her ability to speak or eat, or affects her jaw function. Insurers may be willing to provide full coverage if this is the case.
As with any investment you plan to spend money on, make sure you read through and understand the coverage being offered by an insurer. If you have children, getting coverage may actually be a good idea because children will often need dental work by the time they are 2 years old, up to young adulthood. You will have to spend a lot for the procedures they need, and having an insurance can ease the burden of payments.