FAQs About Dental Insurance

May 11, 2021

With the complicated healthcare system in the United States, it is natural to have some questions about dental insurance. While Dr. Sharma and his team are happy to answer your questions about your coverage and what it means for your dental treatment, it is also helpful to know some of the answers yourself. By answering some of the most common questions about dental insurance, you will be able to budget better. You may also find it easier to decide whether to get dental insurance if you don’t already have it.

Type of Dental Insurance Plans Are There?

There are a few main categories of dental insurance, although all plans are set up slightly differently. The following explains the most common structures.

  • Direct Reimbursement: These plans will usually reimburse for up to a set amount or percent spent on your dental care. It tends to follow the same structure regardless of the treatment and dentist.
  • Usual, Customary, and Reasonable: These plans will pay a “customary” or “reasonable” amount of dental fees, or a set percent, whichever is less. The “customary” amounts may be lower than the actual cost.
  • Schedule or Table of Allowance: These plans cover up to a set dollar amount for each service. You pay the difference between that and the treatment cost.
  • Capitation: These plans involve the insurance company paying dentists a set amount per month per patient and you receiving certain treatments for free in return.

The other way to divide insurance plans is into the following three categories:

  • Fee-for-Service or Indemnity Plans: You get to choose your dentist and will pay a percentage of their fee.
  • Preferred Provider Organization (PPO) Plans: You get slightly lower fees to see in-network dentists than out-of-network ones.
  • Health Maintenance Organization (HMO) Plans: You must see providers in your network. Preventative services are typically fully covered, while other procedures have copays.

What Does Dental Insurance Cover?

Although it varies, most dental insurance plans offer 100/80/50 coverage. This means they cover 100% of preventative care, including x-rays, exams, and cleanings. They cover 70% or 80% of basic periodontal work, extractions, and fillings. They cover 50% of implants, bridges, crowns, dentures, root canals, and other major procedures.

Many plans cover less and some cover more, so always read the fine print.

How Much Will My Dental Insurance Cover?

The amount of dental work covered by your insurance will depend on the type of plan you have. It also depends on how the insurance company determines costs. Every insurance plan is different, so you will have to read your plan’s fine print to estimate your costs. Most plans will also have maximum coverage limits.

Keep in mind that the average cost of dental insurance in the United States is about $360 a year. The typical coverage is capped at $1,000 or $2,000 annually.

Is It Worth Getting Dental Insurance?

There is some mixed advice on whether you should get dental insurance. The consensus is that if it is offered by your employer and will have minimal monthly costs, it will almost always be a good idea. It becomes a bit more complicated if you get an independent dental insurance plan.

For more information on dental care and coverage contact out dental offices in Chicago!

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