Dental plans are designed to share the cost of dental treatment between the insurer and the insured. Most plans cover 50 percent or more of the cost of dental services, but they rarely cover all of it. Still, they can give you a welcome financial cushion when you receive the bill from your dentist's office.
Coverage varies widely, and you should know what you’re getting before you buy. Often, a policy that seems very attractive on the surface will have exclusions that will keep you from getting the most out of your insurance. Don't be caught off guard when your insurance doesn't cover a procedure excluded in the fine print of the plan.
With all the options out there, it can be difficult to figure out which is right for you. Here are six key things you should know about dental insurance before settling on a policy.
1. You Might Not Get Back Everything You Pay
Having a dental plan doesn't mean your entire fee will be covered. Routine procedures like cleanings and X-rays are often fully covered. Major work like root canals, however, rarely are.
Dental plans are unique in the insurance world because the procedures it covers are categorized into classes of service based on their complexity and cost. The procedure's class determines the reimbursement rate. But some plans will use an amount other than you dentist's fees to calculate how much you get back.
Some insurers set an arbitrary customary fee limit. Your will receive a reimbursement that is either a percentage of this fee or a percentage of your dentist's fee – whichever is lower. So, what ends up back in your pocket will depend on your provider.
2. There Are Limits on Treatments and Coverage Varies
High coverage usually means you pay more every month but pay less when you use dental services. Some policies will include a deductible for certain services. And most plans will place limits on the number of office visits, consultations, X-rays, and other treatments they will cover. It pays to do the math on this one. A plan that covers one cleaning a year might have a lower monthly rate but end up costing your more in the long run than a slightly more expensive policy that covers two.
There may also be a wait period before you can get major work done. Many plans will only cover exams, cleanings, and X-rays for the first six or twelve months. Any other dental work you need during that time will be paid out of your pocket.
Plans are often tailored to age groups as well. Coverage for children isn’t necessarily identical to coverage for adults. Be sure to read the fine print to understand how the plan applies to each member of your family.
3. Even if Your Dentist Recommends It, Your Insurer Might Not Cover It
Inexpensive dental plans are often inexpensive for a reason. They may not allow all treatment options, even if they are the best thing for your teeth. For instance, your dentist may tell you your tooth is in bad shape and recommend a crown, but your insurer only covers fillings.
One common complaint is that many plans do not cover white fillings. Instead, the insurer will insist that patients put up with amalgam fillings even though they don’t want them. Many insurers also won't cover preventative measures, such as sealants.
When you purchase a dental plan, the least expensive option isn’t always the best option. Read the fine print, and be certain the insurer covers the procedures you may need.
4. The Sky Is Not the Limit
Most dental plans have an annual maximum for care over the plan year, which isn’t necessarily the same as the calendar year. Most are sufficient for routine care, such as an annual x-ray, cleaning, and checkup. But it's easy to reach your maximum when you need complex or extensive dental work. This is a problem that's all too familiar to many people whose children need braces or other corrective devices.
When looking for a policy, do a bit of homework to estimate possible costs and shop for the best rate for a plan that meets your needs. Dental care costs are high, but maximum levels of reimbursement don’t necessarily match those costs.
5. You May Have to See a Preferred Dentist
Some insurers suggest you choose from a list of the dental plan’s preferred dentists. These dentists are on the insurer’s list because they offer their services at a lower rate. The dentists benefit from the plan’s network and the insurer cuts costs.
While they cannot force you to use their network of dentists, your insurance company can adjust reimbursement rates if you choose another dentist. This means less money in your pocket even though you pay for dental coverage.
Opt for a plan that lets you choose your own dentist to avoid this problem.
6. A Pre-Existing Condition Might Preclude Coverage
Just as with medical insurance, a dental plan may not cover conditions a person had before enrolling in the plan. Clauses may exclude payment if you have bridge work, crowns of dentures under five years old, or if you have partially completed dental work that you need to have finished.
Dental insurance is complex, but with a little due diligence you can find a plan that suits your needs and meets your budget. Check the items mentioned above and always read the fine print so you can keep smiling for years to come.