Dental Insurance Articles

Understanding Different Aspects Of Your Dental Insurance Coverage

2010-12-11

Dental insurance coverage varies. There are several different coverage types. Also types of services within a dental plan are covered at different rates.

A Direct reimbursement plan allows the policyholder to go to the dentist of their choice. The total amount spent on dental care is submitted to the insurer and the patient is reimbursed a percentage of those expenses. This plan does not differentiate between the types of care received.

Capitation or managed care plans use a list of dentists. A Dental Preferred Provider Organization (PPO) has a list of dentists to choose from. Dentists join the PPO in order to get patients and in return give discounts to the insurer. Out of network services are covered at a reduced rate. A Dental Health Maintenance Organization (DHMO) pays the dentist on a regular basis for the number of patients they have. You must use one of their dentists in order to have dental coverage. Dental Point of Service (POS) gives the policyholder the choice when they sign up to use a dentist in the network or to see a dentist of your choice. Often the benefits are different depending on the type of provider chosen.

A schedule of allowance program has a fixed amount that will be covered for each dental service provided. This fee will likely be less than the amount the dentist actually charges. The amount not paid by insurance is the responsibility of the patient.

In an indemnity dental plan service are broken down into three categories. Preventative care includes annual exams, x-rays, and cleanings. Basic dental procedures include fillings, extractions and root canals. Major dental work refers to crowns, bridgework, dental implants, and dentures.

Basic dental work is typically covered at 70% to 80% of what the dental insurance company considers a reasonable fee. Major dental work is typically covered at only 50%. Dental plans also have a yearly maximum that may range from $1000 to $1500 for the year. Dental insurance coverage often has a yearly deductible that must be met before benefits are paid. Sometimes the preventative care services are not subject to that deductible.

Different coverage types handle preexisting dental problems in different ways. If the policy has a "missing tooth" clause then the plan would not pay a crown, bridge or other dental work to fix that gap. If there is a "replacement" limit then the plan will not pay for replacing major dental work, such as dentures, for a certain period of time.

Consider your current policy or any dental insurance quotes to see what kinds of coverage are offered. The other factors to consider include what is covered, the limits of the plan, and any preexisting clauses.