Did you know two-thirds of Americans have private dental insurance? There are many benefits of having a dental insurance plan. Paying a low payment every month can result in serious dental treatment savings.
But understand that all dental insurance plans are different. There are factors that influence all insurance plans, such as deductibles, maximums, and co-insurance. But there are also little-known details that can separate great insurance from less-than-perfect insurance.
If this is your first-time shopping for dental insurance, there are certain plan details you should look for. Look for these 6 details before signing up for dental insurance.
1. Waiting Period
A waiting period is how long you must be on the dental insurance plan before the insurance handles certain costs.
Not all dental insurance plans have a waiting period, but you should make sure you know your insurance’s waiting period and how long that waiting period lasts. For example, you may need to wait six months before the insurance will cover the costs of a major procedure such as a crown.
Fortunately, most dental insurance plans have no waiting period for basic or preventative services. Different plans may also vary with waiting periods. For example, DMHO dental plans are more likely to have waiting periods compared to PPO plans.
Always ask the dental insurance provider if they have a dental waiting period. If there’s a service you need immediately, such as braces, be sure to inform them and see if they will cover that service.
2. Frequencies and Limitations
Every dental plan will have a limitation. For example, you may only have to have a certain number of cleanings every year. Some dental insurance plans may detail how much time must pass in-between each treatment.
Oftentimes, these frequency types aren’t drastically different. For example, one insurance carrier may only cover two dental cleanings and the next insurance carrier may only require two cleanings that are six months apart.
If you will likely receive two dental cleanings every year that are six-months apart, these frequency terms won’t make much of a difference.
Each procedure may also come with limitations. Common limitations include X-rays, exams, crowns, and fillings.
What if you need more treatments? What if you need something not covered under the plan, such as an X-ray?
It’s important that patients receive the required amount of dental treatments. But if you know you need more cleanings and other limitations compared to the average person, shop around and find a full-coverage dental insurance plan that covers the number of treatments you need.
3. Sealant Coverage
Dental sealants are a clear protective coating that reduces the risk of cavities. They serve as a seal around your tooth, preventing food and plaque from decaying your teeth.
Most dental plans include sealants on insurance, especially for kids and teenagers. Most dental sealant coverage lasts for three years.
Every patient should consider getting dental sealants. While these are mostly applied to children’s teeth, adults can get them, too. Even if you don’t struggle with frequent cavities, sealants offer many oral health benefits.
If you’re interested in dental sealants for you or your child, you’ll want to look for dental insurance that covers this treatment. In case an insurance carrier doesn’t cover sealants then don’t worry — most only need sealants on a few teeth (usually your back molars) and it’s still cheaper than filling a cavity.
4. Benefit Categories and Coverage
Many dental insurance plans separate their coverage into different categories and each category has a different coinsurance level. For example, basic and preventative procedures could be 80% covered while major procedures may only be 50% covered.
The different categories and coverage percentages will impact the overall price of the insurance.
If an insurance plan is higher priced than others, see if that plan covers more than other plans you’re looking at. If so, the higher price may be worth it. You can also purchase supplemental dental insurance to enhance your coverage.
This detail is also important if you’re buying dental insurance for your children. At the very least, the insurance plan should cover diagnostic and preventative care and common restorative care. If you can’t find a plan that covers 100% of these costs, it should at least cover the majority of the costs.
5. Missing Tooth Clause
What if you lose a permanent tooth and are buying an implant or a bridge? Don’t be surprised if your dental insurance plan has a missing tooth clause.
If you lost a tooth before the dental policy was purchased, the insurance company won’t cover the replacement tooth. In other words, they consider your missing tooth to be a “pre-existing condition.”
Keep in mind, if you lose your tooth after you purchase a dental insurance policy, the insurance will cover the cost to replace that tooth.
Unfortunately, many people don’t know about this clause. But there are plenty of dental insurance plans that don’t have a missing tooth clause.
If you need assistance paying for an implant or a bridge, mention this to the insurance provider and see if they offer dental insurance without a missing tooth clause.
6. Network Strength
When you purchase your dental insurance, you’ll want to make sure lots of dentists accept that insurance. The larger the dental network, the more likely you’ll find a dentist you really like.
This isn’t the only detail to look for. You’ll want to know how insurance companies work with dentists and how they will protect your oral health while you save money.
The best way to find a great dentist is by asking the dental insurance company. If you have great insurance, they will likely only work with great dentists.
You’ll Be Better Protected With Dental Insurance
Do you need dental insurance? If so, there are many details to review in the plan before you sign or buy anything. If there’s a dentist you like, you can also discover what insurance plans they accept and which insurance providers they recommend.
If you’re in the Westport area of St. Louis, Missouri, feel free to contact us and ask about insurance.
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