Approximately 77 million Americans have dental benefits with private coverage through an employer or group program. Many people are familiar with medical insurance, but dental insurance works a bit differently, so it isn’t always the easiest thing to navigate. To completely maximize your coverage, it pays to know a little bit about your plan. Continue reading to learn about the most common types of dental insurance plans so you will know what to expect.
The Types of Dental insurance Plans
Dental insurance plans can vary quite a bit. Here are two of the most common options.
- Dental Health Maintenance Organization (DHMO): With this type of insurance plan, your dental insurance provider will give you a list of dentists that will accept your plan for a set co-pay or no fee. However, you won’t receive any coverage If you see a dentist who is not on your list of in-network dentists.
- Preferred Provider Organization (PPO): A PPO plan gives you the option to choose whichever dental provider you want. You will still have a list of dentists who are in-network with your plan, but you still have the option to choose one that is out-of-network. However, if you do this, you are likely to end up with higher out-of-pocket costs.
What’s Included in Your Dental Insurance Plan?
The most common dental insurance plan follows a 100-80-50 coverage structure. Typically, this means that they will cover the following dental treatments and procedures.
- 100% of Preventive Care: This includes regular cleanings, checkups, routine X-rays, and more.
- 80% of Basic Procedures: Basic procedures are fillings, gum disease treatment, and other non-invasive procedures.
- 50% of Major Procedures: Services like dental crowns and orthodontic treatment often fall into this category.
4 Dental Insurance Terms You Should Know
Here are some terms that will come up often as you are learning more about your dental insurance plan.
- Coinsurance: If you have a fee-for-service plan, they will pay a predetermined percentage of the cost of your treatment and leave you responsible for paying the remaining amount. This part of your out-of-pocket cost is known as “coinsurance.”
- Copayment: If you have a closed network, prepaid, fixed copayment plan, you will pay a set dollar amount for covered services instead of a percentage.
- Deductible: This is the amount that you pay every year out-of-pocket before your insurance begins to cover treatment costs. This doesn’t usually apply to diagnostic and preventive treatments.
- Maximum: This is the most money that your plan will cover within one-benefit period. The remaining costs will be left to you.
The year is coming to a close, and your unused benefits will not carry over to 2027. If it has been a while since your last checkup or you need dental work, now is the time to schedule an appointment. Use your benefits before you lose them!
About the Author
At Comal Dental, Dr. Aaron Haag and Dr. Sarah Hansen work together to treat patients in the New Braunfels area. They both earned their dental doctorates from the University of Nebraska Medical Center College of Dentistry. If you have concerns regarding your dental implants or want to learn more, they would be happy to help. They are in-network with most major PPO dental insurance plans. For more information or to schedule an appointment, visit their website or call (830) 999-2492.
