What services does your dental insurance cover?
Unfortunately, this question is all too common in regards to dental insurance and is confusing for many people. Luckily, it doesn’t have to be.
Knowing where to look for answers to questions about your dental insurance is key to making the most of your insurance plan. It will make maintaining good dental health easy without affecting your budget.
Learning about what dental services are covered by your specific dental insurance plan by talking your dental insurance provider, and then talking to your dentist about dental payment plans is usually the best thing you can do.
In-Network Dentists: PPO vs HMO
Most dentists work under several dental services agreements. Yours depends on what type of insurance you have. Here are the differences:
- Preferred Provider Organization (PPO): Through a PPO, your insurance provider negotiates with individual dentists in your area. They obtain specific rates for different dental services. These are “in-network dentists”. If you go to a dentist outside of your PPO network you could end up paying most, or all, of the costs.
- Health Management Organizations (HMO): HMO plans aren’t as flexible as PPO and require that you choose a primary dentist for all of your dental services. This may require a referral for any outside dental procedures if necessary.
How Much of the Cost Does Dental Insurance Cover
The cost for your dental service(s) depends on your insurance coverage, plan, and the service(s). Checking these things with your dental insurance provider will make the process a whole lot smoother:
Dental Services Categories
Most dental plans group procedures into one of three categories. The category in which they fall determines coverage and deductibles. These categories include:
- Preventative: This tier will cover preventative dental services. These include teeth cleaning, x-rays and general examinations. Most dental plans should cover 80-100% of these costs.
- Basic: Basic dental services include emergency pain relief, fillings, tooth extractions, root canals and some dental crowns. These plans cover 70-80% of costs.
- Major: Major dental services include more complex dental procedures. These can be tooth implants, impacted wisdom tooth removal, oral surgery, or dentures. Usually, plans cover 50% of these services.
Your plan should list a deductible, a fixed rate for all visits, for dental visits and other procedures. Reducing your insurance costs is possible by increasing your deductible. If additional dental services are required in a given year, this option can actually be more expensive.
Most dental plans will have a maximum payout where they will cap you after $1000-$2000 of dental services. You can reach this limit very quickly if any major work is required; any additional dental expenses require out of pocket payment.
Get Explanation of Benefits From Your Dental Insurance Provider
Your insurance provider’s explanation of Benefits (EOB) identifies the benefits, coverage amounts, and restrictions on your dental insurance plan. Referring to this document gives you the best information about your insurance plan. Your EOB includes your UCR, copayment amounts, benefits, deductibles, and paid benefits.
Looking for more advice about dental insurance in Columbia, MD?
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