Dental Insurance – Top Benefits and How It Works

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A warm and engaging smile is among the best assets you can have. However, it depends to a great extent on how well formed, aligned, and maintained your teeth are. Regular visits to the dentist for cleaning, maintenance, and correction of dental issues can be expensive. Due to the expense, many people tend to ignore their dental problems, which can mount over time with painful and even more financial disastrous consequences. For this reason, you need to consider dental insurance, which you can buy as a standalone policy or as part of your medical insurance.

How Dental Insurance Works

Just like medical insurance, you need to choose a plan offered by the insurance companies based on the coverage and the amount of premium how much you can afford. If you have a dentist, you can take an insurance policy from the insurance company that includes him in its network to get a less expensive plan. If you visit a dentist not included in an insurance company’s network, but you will pay much more. If you do not have a regular dentist, you can choose one from the insurance company’s network of dentists in your area. The premium depends on various factors like the insurance company, the chosen plan, and your location.

Waiting Period

Most insurance companies do not allow policyholders to avail of any treatment under the insurance policy for a waiting period ranging from six months to twelve months. The waiting period for major work can be even more, sometimes up to two years. The insurance companies enforce these waiting periods to ensure that people do not apply for a new policy knowing that they will be soon undergoing treatment under insurance cover. The waiting period ensures that insurance companies do not make a loss by selling new policies.

Deductibles, Copays, and Coinsurance

Depending on the structuring of your dental policy, you may need to agree to a deductible. According to Forbes, a deductible is a specified dollar amount you pay before the insurance coverage kicks in. The insurance companies enforce it to prevent frivolous claims. The insurance company will pay for the cost of the treatment less the compulsory deductible, which means if it is less than the deductible amount, you need to pay the bill yourself without the insurance company paying anything.

If your insurance plan also includes copays, you will need to pay the copay, a fixed dollar amount, at the time you take the service at the dentist’s clinic or the pharmacy. Depending on your insurance plan, the copay amount may qualify as the deductible. Your insurance plan may also specify coinsurance of a certain percentage. You will need to pay the specified percentage of your treatment amount less the deductible, while the insurance company will pay the rest. The insurance premium depends on the deductible and copay, and coinsurance. The lesser the insurance company’s exposure, the lower is the premium amount.

Categories of Dental Insurance

Most Huntington Cigna dental insurance plans pay 100% for preventive care but 80% for basic dental procedures and 50% for major treatment. Preventive care includes annual or half-yearly visits to the dentist for cleaning, sealants, and X-rays. Basic dental procedures comprise extractions, gum disease, fillings, and root canal treatment. Most insurance policies pay 80% of the cost of treatment, with the rest 20% accounted for by deductibles, copays, and coinsurance. However, the insurance company’s coverage is restricted to only 50% of the cost of major procedures like dentures, crowns, bridges, etc., with the patient paying the rest.

There is no standardization of the treatment categories across different insurance companies, so comparing different policies may be beneficial. For example, some insurance policies categorize root canals as major, while others classify them as basic procedures. Patients who may require the more expensive treatments will do well to pay attention to the coverage of dental insurance plans for optimizing the coverage and premium amount, particularly the limits and exclusions.

Cosmetic Dental Procedure Not Covered

You should understand that most insurance plans do not cover the cost of cosmetic dental procedures like gum contouring, tooth shaping, whitening, veneers, etc. since these only improve the appearance of your teeth and do not qualify as medical necessities. Accordingly, you will have to pay the entire cost of the treatment. While many people opt for braces to improve their smiles, some insurance companies will pay for it if you purchase a special rider at an additional cost or wait for a long period.

Maximum Coverage Amount

Most dental insurance policies limit annual coverage despite the clauses for deductibles, copays, and coinsurance. The maximum coverage offered by the insurance ranges from $1,000 to $2,000 per year. The premium you pay depends on the coverage amount. If a patient exhausts the yearly maximum, he needs to pay the entire cost of all dental treatments over and above the yearly maximum. Often, insurance companies offer policies that allow for rolling over the amount of the unutilized annual maximum to the following year.

Tax Credits

Rules permit you to use your tax credits to pay for dental insurance premiums for your children if you have any left after purchasing health insurance for your family. However, you can do this only if your insurance plan does not have dental cover for your children. You cannot buy an additional plan if your existing one provides dental coverage for your children.

Conclusion 

Purchasing dental insurance cover is simple and necessary, given the steep costs of treatment. The premium amount depends on many factors like the amount of cover, location, deductible, copay, coinsurance terms, and the kind of plan selected. Different insurance companies like doodle have different ways of classifying treatment into preventive, basic, and major procedures, according to which they will cover the full or part of the cost of the treatment. No insurance company pays for cosmetic dental work, save for braces by some. If you spend more than the maximum cover of the policy, you will need to pay the cost yourself. On the other hand, if you do not spend the entire covered amount, the insurance company may allow you to carry forward the balance to the following year.