Dental Insurance: What Does Your Plan Cover?

Dental insurance coverage is significantly different from medical insurance. Unfortunately, that’s why several patients get confused about what their plan actually covers. It’s worth noting that benefits can vary from person to person, which is why it’s crucial to review the details of your unique plan and understand how it works. With that in mind, your dentist in Pewaukee has created a basic outline of what the average dental insurance plan covers.

Types of Dental Insurance

Let’s take a closer look at some of the most common types of dental insurance plans:

• Preferred Provider Organizations (PPO) – These plans allow you to have more flexibility when choosing a doctor or hospital. Although they provide a list of preferred in-network dentists, you can go out of network if you’re okay with paying the extra costs.
• Dental Health Maintenance Organization (DHMO) – With this plan, you’re provided a network of dentists that have agreed to set dental insurance rates, including copays. You won’t have a benefit maximum or deductible, but you’re only limited to in-network dentists.
• Dental Discount or Dental Savings Plan – These plans allow members to choose from a select group of participating dentists who charge lower rates for their services. However, none of your care is covered by insurance – you pay the entire discounted rate out-of-pocket.

What Does Dental Insurance Cover?

Every dental insurance plan is unique, but most usually follow a 100-80-50 structure for coverage. Here’s what that looks like:

• 100% – Preventive dentistry services like checkups, cleanings, oral cancer screenings, and routine X-rays are usually fully covered.
• 80% – Basic treatments like fillings and periodontal therapy are covered at a slightly lesser percentage.
• 50% – More complex procedures like root canals, bridges, dental crowns, and extractions typically have the least amount of coverage.

Dental Insurance Terms You Should Know

Most Americans pay about $360 yearly for dental insurance, which averages to around a $15-$50 monthly payment. Keep in mind that factors like the amount of coverage you want and the state you live in can affect your rates.

To better understand your coverage and the costs involved, here are some terms you should know:

• Premium – This is your monthly payment for your dental insurance plan.
• Deductible – This is what you might need to pay before your insurance plan starts paying.
• Copay – This is what you pay every time you visit your dentist.
• Coinsurance – This is the percentage of costs you pay after you meet your deductible.
• Annual Maximums – This is the most your insurance plan will pay for coverage in a plan year.

Now that you have an idea of what your dental insurance plan covers, you can make the most of it and keep your smile in its best shape possible!

About the Author

Dr. Gina Ostrand enjoys giving her patients the personal, one-on-one attention they deserve. She earned her dental doctorate from Marquette University’s School of Dentistry in 1992. After graduating, Dr. Ostrand attended numerous hours of continuing education every year to stay up to date on the latest developments in dentistry. If you need help understanding what your dental insurance plan covers, she’ll be more than happy to assist you. You can reach Dr. Ostrand via our website or call (262) 695-8600.