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Dental Insurance Basics: What Does Your Plan Cover?

October 16, 2020

Filed under: Uncategorized — kingscott @ 11:19 am
dental insurance paperwork on dark wooden table

About three-fourths of Americans currently have some form of dental insurance, according to the National Association of Dental Plans. However, many people aren’t quite sure exactly how dental insurance works. As a result, they might end up overpaying for the care they need, or even not getting that care at all. Here are some dental insurance basics to help you understand how your plan works and what kind of coverage you can expect.  

Dental Insurance Terms to Know

Sometimes, the technical-sounding language your insurance company uses can be confusing. To make understanding your policy a little bit easier, here are a few important terms you should know:

  • Premium: What you must pay every month to qualify for coverage from your insurance.
  • Deductible: What you have to pay before the insurance company steps in and starts covering your care.
  • Annual maximum: The highest amount your insurance company will pay for your dental care during a given period (usually a calendar year).

The 100-80-50 Rule

Every dental insurance policy differs, but most of them follow a similar basic guideline in terms of which services are covered and to what extent. You can typically expect:

  • Preventive and diagnostic care, including cleanings, x-rays, and oral cancer screenings, are typically 80-100% covered.
  • Basic procedures, such as fillings and gum disease therapy, are usually covered at 70-80%.
  • Major treatments, like root canal therapy and dental crowns, are generally only covered up to 50%.

Depending on the details of your individual plan, some services may fall under different categories and qualify for different amounts of coverage. Your dental team can help you review your specific policy to understand your complete list of benefits.

The Importance of Maximizing Your Dental Insurance Benefits

Multiple studies indicate that most Americans with dental insurance leave almost $1,000 of benefits on the table at the end of each year. More often than not, any unused benefits disappear once the year ends. To prevent whatever you have left of your annual maximum from going to waste, schedule any necessary dental work before 2020 draws to a close. Plus, utilizing the preventive care you’re entitled to can net you long-term savings. Regular checkups and cleanings can detect and treat oral health issues before they become larger, more expensive issues.

These basics should be enough to help you get an idea of how your dental insurance works and what it covers. However, if you’re still unsure about some aspect of your plan, feel free to call your dentist’s office. Their team should be more than happy to help!

About the Author

Dr. L. King Scott is a dentist in West Monroe, LA with almost 40 years of dental experience. In addition to earning a Mastership with the Academy of General Dentistry, he has achieved its highest honor: the Lifelong Service and Recognition Award. His family practice accepts all major dental insurance plans and will file claims on your behalf. To learn more about making the most of your benefits, call Dr. Scott’s office at 318-325-4600.

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