How Does Dental Insurance Work?

For many of us, a new year means new insurance, and although you may believe that having and using one is vital, for many of us, understanding their dental insurance can be quite confusing. Maximums, deductibles, exclusions, networks, waiting periods, missing teeth clauses – this all might end you up scratching your head and wondering, ”how does dental health insurance work?’

But do not fret anymore; we have especially put together this post to help you decipher and understand what dental plans are and how it works to help you get the most out of your insurance.

What is Dental Insurance?

It is a form of insurance that helps individuals to pay for their dental care. Although each dental insurance plan’s features and particulars differ, they generally include coverage for preventive care such as routine checkups, cleaning, and x-rays. Additionally, most plans for insurance that pays for treatment by a dentist also include coverage for dental services like root canals, fillings, crowns, extractions, and in some cases, orthodontics.

The insurance plan you select will dictate how much you and the insurance company will pay, and it might even infer which dentist you’ll have to visit to redeem the insurance. Several people do not realize this but understanding your coverage can help you significantly help take advantage of the insurance plan and know what you’re responsible for.

How Does Dental Insurance Work?

Finding a decent dentist is the easiest piece of the puzzle, once you find one, you’d want to know how much you’ll have to pay for a visit. Now, this depends entirely on the pre-determined particulars of your dental services insurance plan. Mostly, dental care plans use a calendar year approach to establish when certain benefits are available for use.

The dental office is usually responsible for verifying your plan and establishing how much you’ll be expected to pay. Post your dental visit, a request for payment, also known as a ”claim”, is sent to your insurance coverage organization. The company reviews and processes the claim to explain how it will be paid (EOB or explanation of benefits).

Ultimately, your financial obligation is based on your dental care plan’s specifics and the treatment you receive. Some particulars of your plan might include the following:

Annual Maximum: The maximum amount of payment the insurance company will cover during the benefit year. Once it is reached, additional expenses will have to be paid from your pocket.

Deductibles: The amount you pay before the insurance firm pays anything.

Coinsurance: Once the deductible is met, a percentage of the treatment cost will have to be paid by you. For example, you might have to pay 30 percent for the cost of a major procedure.

Exclusions: Products or services that will not be covered through insurance.

Co-Pay: Fixed charge for a specific procedure.

Limits: Several dental care plans have time limits for specific procedures. For instance, your insurance plan might cover two cleanings per year, but only if six months have passed between them.

Preauthorization: Some dental plans might require you to get approval from the insurance company before the commencement of treatment.

Pre-Existing Conditions: some dental plans do not pay for pre-existing conditions that you might have had before signing up for their plan.

Waiting Period: Major procedures like crowns or teeth replacement are not covered in some insurance plans until a specific amount of time has passed.

Dentist in Bowie, Maryland

Hopefully, this blog post helped you understand how insurance works and why it is integral to understand your dental care plan. Knowing how the insurance works will eventually allow you to make better dental care choices and lead to a healthier and happier smile!

Our dental team is always here to help you achieve optimal dental care while optimizing the benefits of your insurance. Call us at (301) 464-1800 to book an appointment or check our website to learn more about our dental products and services.