What is dental insurance?

Generally speaking, dental insurance is a contract between your employer and a dental insurance company. The benefits are based on the terms of the contract that were negotiated between your employer and the dental insurance company; not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company.

How are my benefits determined?

The benefits you receive From your dental insurance depends on several factors:

  • Percent coverage: Dental insurance companies rarely cover 100 percent of any dental fee and in many cases, cover less than 50 percent or nothing at all. Coverage can vary for preventative, basic restorative and major restorative treatment.
  • Covered procedures: The selection of non-covered services is not based on what you need or want, but is based strictly on the contract between your employer and the insurance company.
  • Yearly maximum: There is typically an annual limit to what the insurance company will pay. Once this amount is reached, no additional coverage is given. The average plan has an annual maximum benefit of $1,000 to $1,500.
  • Deductibles: Many plans have an annual deductible that must be met before the insurance company will pay for treatment. This can range From $25 to $100 per covered person per year.
  • Frequency: Preventative procedures often require a certain amount of time between visits in order to be covered (cleanings, exams and X-rays are common examples).
  • Waiting period: Many plans have a period of time that your policy must be in force before your benefits begin (typically six months to one year).

Dental insurance: myth vs. fact

Myth: Dental insurance is the same as medical insurance.

Fact: People who have dental insurance really only have minor dental benefits. A dental benefit is more like a discount. It doesn’t pay for the entire product or service, and is usually reduced by maximums, deductibles, waiting periods, etc., as noted above. The main purpose of dental insurance is preventative care. Dental insurance offers the highest coverage for services that keep your oral care in check, such as cleanings, exams and oral cancer screenings, only some coverage for restorative and little to no coverage for cosmetic care. Health insurance typically focuses less on preventative care and more on unforeseen injury and illness.

Myth: If a dentist recommends that work needs to be done, dental insurance will cover the work.

Fact: Covered benefits have nothing to do with recommended and/or needed treatment. Dental plans determine the maximum coverage and covered procedures prior to any dental visits. Each dental plan sets their own guidelines for what they cover and how often.

Myth: My dental benefits greatly outweigh the premiums paid.

Fact: In the past, dental insurance premiums were paid for by the employer, and most plans paid 100 percent of preventative care and 80 to 100 percent of needed restorative treatment. Nowadays, most premiums are either shared by employee and employer, or paid entirely by the employee, and most restorative treatment is covered at 40 to 80 percent.

Myth: “In-network” providers will provide better treatment than “out-of-network” providers.

Fact: The in-network status of a provider has nothing to do with its credentials or quality of care. When a provider agrees to become an in-network provider, they are essentially agreeing to offer the services at a lower price to the patient. Seek a qualified, reputable dentist who is able to focus their practice on providing a high level of customer service, even if that means they are out-of-network and you pay a little more for the care.

To learn more, watch this great video demonstration on purchasing dental insurance:

Edwin Batchelor, DDS, is a partner at Excellence in Dentistry, which has locations in Madison and Cottage Grove. Dr. Batchelor graduated From the University of Missouri at Kansas City School of Dentistry. He is certified in oral conscious sedation, helping provide care for those with phobias or fear of treatment. Dr. Batchelor is on the board of directors for the Wisconsin Academy of General Dentistry. For more information, call (608) 240-1001 or visit www.excellenceindentistry.com.

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