Dental Insurance 101: Everything You Need to Know

Author

Reads 807

Woman Having Dental Check-up
Credit: pexels.com, Woman Having Dental Check-up

Dental insurance can be a lifesaver, but it can also be overwhelming. Most dental insurance plans have a waiting period, which can range from 6 to 12 months for major procedures.

The average annual cost of dental insurance is around $1,000 to $2,000 per person. This can vary depending on the type of plan and the provider.

Not all dental insurance plans cover the same procedures. For example, some plans may cover routine cleanings and check-ups, but not more expensive procedures like root canals or crowns.

Dental insurance can be purchased individually or through an employer.

Understanding Dental Insurance

Dental insurance can be overwhelming, but understanding the basics can make a big difference.

You should pay special attention to your coverage and network before seeking dental care. If you have a Delta Dental PPO-only plan, your coverage only works when you receive care from an in-network dentist.

More than 4 out of 5 dentists in Minnesota participate in one or both networks, making it easy to find a participating dentist. You can find the network your dental plan utilizes on your ID card and in your benefit booklet, or by calling customer service.

Credit: youtube.com, Dental Insurance 101 - Understanding Your Coverage

Preventive care, such as cleanings and oral exams, is usually covered at a high rate, often 100%. Restorative and major services, like fillings and crowns, are reimbursed at different rates, and the percentage of coverage or flat fee cost varies by plan.

An Explanation of Benefits (EOB) statement is sent to you each time you visit the dentist, explaining how your claim was processed. The EOB includes any balance you're responsible for paying the provider and how much has been credited toward any required deductible or annual maximum.

Here's a comparison of out-of-pocket costs for different types of providers:

As you can see, selecting a Delta Dental PPO dentist may be a more cost-effective option for you, as the Maximum Allowable Fee is typically less than the Delta Dental Premier network.

Importance and Benefits

Dental insurance can make a big difference in your oral health and your wallet. It not only affects your revenue as a practice owner, but also influences patient decision-making, with many patients choosing a dentist based on their insurance network.

Credit: youtube.com, Dental Insurance 101

Regular dental visits are encouraged by insurance, which can lead to more consistent revenue for the practice. Patients with dental insurance are more likely to visit dentists for preventive care, improving oral health.

Preventive dental care is critical to maintaining good overall health, and researchers continue to identify links between oral and overall health. Even with proper preventive care, sometimes major dental health issues happen, and you may need an expensive procedure.

Here are some benefits of having dental insurance:

  • An ounce of prevention is worth a pound of cure. Regular dental exams and cleanings identify problems before they become more serious, painful, and expensive.
  • Save money through a dental plan network. Many plans allow you to visit out-of-network dentists, but you will usually save more if you get care from a dentist who participates in your plan’s network.
  • Provides financial protection. Your dental plan can limit your out-of-pocket costs in the event of a dental emergency.

Why You Need

You need dental insurance to protect your wallet and your health. Without it, you'd have to pay the full cost for any dental care you may need, which can be a huge financial burden.

Over 2 million emergency room visits each year in the U.S. are due to untreated dental problems. This is a staggering number, and it highlights the importance of regular dental care.

Regular dental exams and cleanings can identify problems before they become more serious, painful, and expensive. This is especially true for untreated tooth decay, which can result in the need for a root canal or crown.

Credit: youtube.com, The importance of benefits management

Here are some reasons why you need dental insurance:

  • Preventive dental care is critical to maintaining good overall health.
  • Oral issues can result in the formation of harmful levels of bacteria that spread through the bloodstream and worsen medical conditions such as diabetes and heart disease.
  • Save money through a dental plan network by visiting in-network dentists, who negotiate special, lower rates with insurance companies.
  • Provides financial protection in the event of a dental emergency, limiting your out-of-pocket costs.

In short, dental insurance is a must-have for anyone who wants to maintain good oral health and avoid costly dental problems.

Preventive Care

Preventive care is a crucial part of maintaining good oral health, and it's essential to understand its importance. Regular dental visits can help you avoid or lessen the effects of cavities, enamel loss, and gum disease.

Preventive care includes exams, cleanings, and X-rays, which are typically covered at 100% by most dental plans. These services can help identify problems before they become more serious, painful, and expensive.

A preventive visit usually includes an evaluation, X-ray, and a cleaning. During the evaluation, the dental staff will ask about medical conditions, medications, and lifestyle to evaluate the effect of dental health on the whole body.

Some plans cover preventive services for children, such as sealants, at no additional cost. Regular dental visits can also improve oral health and potentially lead to more consistent revenue for the practice.

Credit: youtube.com, The Importance of Preventive Care

For most people, an exam and cleaning are recommended every six months. If you have a medical condition or issues with your teeth and/or gums, your dentist may recommend treatment more frequently.

Here are some benefits of preventive care:

  • Helps identify problems before they become more serious
  • Improves oral health
  • Potentially leads to more consistent revenue for the practice
  • Covered at 100% by most dental plans
  • Includes exams, cleanings, and X-rays
  • Can help prevent cavities, enamel loss, and gum disease

Getting and Using Insurance

You can get dental insurance through various channels, including the Health Benefits Exchange, such as the Washington Health Benefit Exchange (WAHBE), or by purchasing a standalone plan directly from the insurance carrier.

Standalone plans are a good option if you don't have health insurance or if you're looking for a more flexible plan. These plans can be purchased even if you don't have any other health insurance.

In Washington State, you can buy a dental plan through the WAHBE, but you'll need to purchase it along with a medical insurance plan, unless you're over 65 and qualify for Medicare.

How Do I Get?

If you're looking to get dental insurance outside of your place of employment, there are a couple of different ways to buy an individual dental plan. You can purchase a dental insurance plan through a health benefits exchange, such as the Washington Health Benefit Exchange (WAHBE), which offers plans designed to meet the needs of families with varying budgets.

Patient at Dental Clinic during Procedure
Credit: pexels.com, Patient at Dental Clinic during Procedure

Currently, unless you're over 65 and qualify for Medicare, dental insurance plans can only be purchased through the exchange along with a medical insurance plan. This means you'll need to have a medical insurance plan to buy a dental insurance plan through the exchange.

You can also buy a standalone dental insurance plan directly through the insurance carrier. This way, you can purchase a dental plan even if you have no health insurance.

Using My Individual

To find a dentist in your network, start by looking for one that's part of your plan's network, like Delta Dental's PPO or Premier Network.

You may choose any dentist to provide dental services under almost all individual plans, but out-of-pocket costs may be higher with a Non-Participating Dentist.

Verify coverage and benefits with your dentist's receptionist or billing specialist, who can look you up in the insurance company's system.

Many dental insurance plans no longer issue physical cards, so this direct line is crucial for getting your coverage and benefits right.

Credit: youtube.com, How to Get Health Insurance When Self-Employed

To file a dental insurance claim, your dentist will usually submit claims for you, and Delta Dental of Washington processes claims within 30 days.

You'll receive a notice, called an Explanation of Benefits (EOB), showing what was paid on your claim and how benefits were applied.

To get the most out of your individual dental plan, be sure to read your EOB carefully to understand your coverage and benefits.

If you're looking to buy an individual dental plan outside of your employment, consider purchasing through a health benefits exchange, like the Washington Health Benefit Exchange (WAHBE).

Standalone plans are also available, and you can buy a dental plan even if you have no health insurance.

An individual dental plan is coverage you buy for yourself and/or your family directly from an insurance company or through the Health Insurance Marketplace.

Using Your Benefits

Now that you've enrolled in your dental plan, it's time to start using your benefits. You can expect to receive an explanation of benefits (EOB) statement each time you visit the dentist.

Credit: youtube.com, Strategies for Health Insurance and Benefit Design - Employer-Sponsored Insurance

An EOB is not a bill, but rather a statement that explains how your claim was processed based on the services performed. It will show you any balance you're responsible for paying the provider, as well as how much has been credited toward your deductible or annual maximum.

You can request a pre-treatment estimate from your dentist's office to understand how your plan will cover the services you need. This estimate will help you avoid any surprises and speed up the processing of your dental claims.

Pre-treatment estimates are especially important for complex procedures like crowns, root canals, bridges, dentures, and implants. Your dentist's office may submit a pre-treatment plan prior to doing any work to see how much each procedure is covered under your plan.

Some dental services may require prior authorization, which involves submitting additional documentation to determine if the recommended treatment is medically necessary or meets your plan's criteria for coverage. These services typically include periodontal treatment, oral surgery, endodontic treatment, orthodontics, crowns, bridges, dentures, or partials.

To make the most of your dental plan, take a few minutes to review your EOB statement each time you receive it. Compare it to the receipt or statement from your dentist to ensure everything is accurate.

Credit: youtube.com, COBRA Insurance | What You Need to Know

Here's what to look for in your EOB statement:

  • Any balance you're responsible for paying the provider
  • How much has been credited toward any required deductible or annual maximum

If you have any questions about filing claims or need help understanding your EOB, don't hesitate to reach out to your insurance provider. They're available to assist you Monday through Friday, 8 a.m. to 8 p.m. ET.

Financial Management

Financial management is a critical aspect of dental insurance. It's essential to understand the cost of providing each service, including direct costs like supplies and labor, as well as indirect costs like rent and utilities.

To set fair fees, consider the fees charged by other dental practices in your area, but don't feel pressured to match them exactly. It's also important to understand the reimbursement rates set by dental insurance companies you work with.

A financial policy should outline how your practice handles insurance claims, out-of-pocket costs, payment plans, late payments, and other financial matters. It should be clear, comprehensive, and provided to all patients.

Credit: youtube.com, Dental Insurance 101 - What is an Annual Maximum?

Here are some common out-of-pocket costs associated with dental insurance:

  • Deductibles: The fixed amount you may need to pay for covered services before your insurance plan begins paying.
  • Copayments: The fixed amount you pay at each visit to the dentist.
  • Coinsurance: A fixed percentage of a treatment cost you share with your dental plan.

Financial Management for Your Practice

Managing the financial aspects of your dental practice requires careful attention to several key areas. Understanding the cost of providing each service is crucial for setting fair fees.

To start, conduct a thorough cost analysis, including direct costs like supplies and labor, as well as indirect costs like rent, utilities, and administrative expenses. This will give you a solid foundation for determining your fees.

Market research is also essential, as it helps you understand what other dental practices in your area are charging. While you don't need to match these fees exactly, being significantly higher or lower could impact your competitive position.

Here are some key points to consider when managing the financial aspects of your practice:

  • Cost analysis: Understand the direct and indirect costs of providing each service.
  • Market research: Research the fees charged by other dental practices in your area.
  • Insurance reimbursement rates: Understand the reimbursement rates set by dental insurance companies.

Creating a clear and comprehensive financial policy is also vital. This document should outline how your practice handles insurance claims, out-of-pocket costs, payment plans, late payments, and other financial matters.

Credit: youtube.com, Financial Planning for Your Practice

Transparent communication with patients is also essential. Make sure to discuss costs and payment expectations with patients before treatment, including providing cost estimates and explaining their insurance coverage and out-of-pocket costs.

To streamline your financial management, consider investing in a robust practice management software that can automate claim submissions. Regularly tracking and analyzing your practice's revenue, including payments from insurance and patients, can also help you identify trends and make informed business decisions.

What You Pay

When you have dental insurance, you'll need to pay regular payments, known as premiums, to keep your coverage. Premiums are like a subscription fee that ensures you have access to dental care.

You may also need to pay cost-sharing payments, or out-of-pocket expenses, for certain treatments. These expenses help keep premiums more affordable for everyone.

A deductible is a fixed amount you must pay for covered services before your insurance plan begins paying. For example, if you have a $50 deductible, you'll pay that amount before your plan covers the remaining cost.

A Man with Open Mouth at Dental Clinic
Credit: pexels.com, A Man with Open Mouth at Dental Clinic

Copayments are fixed amounts you pay at each visit to the dentist. A dentist in your network will charge you for a covered service based on a set rate listed in a fee schedule. Copayments don't apply to your deductible.

Coinsurance is a fixed percentage of a treatment cost you share with your dental plan. You must first meet your deductible and not exceed your plan's annual maximum for the year.

Here's a breakdown of the different types of cost-sharing payments:

  • Deductible: A fixed amount you must pay for covered services before your insurance plan begins paying.
  • Copayment: A fixed amount you pay at each visit to the dentist.
  • Coinsurance: A fixed percentage of a treatment cost you share with your dental plan.

Out-of-pocket costs are often capped for pediatric dental coverage. This is called an out-of-pocket maximum and is the total amount you'll pay for your child's dental care during a calendar year.

Types of Insurance and Networks

There are several types of dental insurance plans, each with its own network of providers. A Preferred Provider Organization (PPO) plan, like BlueDental Choice, offers the most savings when you choose dentists in their network, where fees are lower for routine services.

Dentist Working on Woman 's Teeth
Credit: pexels.com, Dentist Working on Woman 's Teeth

You can also choose from a smaller network with a prepaid plan, like BlueDental Care, but you'll have no out-of-network benefits. PPO plans, on the other hand, allow you to see any dentist, but you'll get more savings by choosing a dentist in their network.

Most dental plans have a provider network, which is a group of dentists that work with the insurer to provide services at a set fee. This can help you save money on out-of-pocket costs and ensure high-quality care.

Types of Insurance and Networks

With so many types of dental insurance plans out there, it can be overwhelming to choose the right one. Some plans don't cover cosmetic dental services like teeth whitening or veneers.

Cosmetic dental services, such as teeth whitening or veneers, may not be covered by a dental plan. This means you'll have to pay out of pocket for these services.

Orthodontic services, like braces and retainers, may also not be covered by some plans. You'll need to check the details of the plan you're shopping for to see if they're included.

African American woman sitting in dental chair and receiving treatment with curing light from crop doctor
Credit: pexels.com, African American woman sitting in dental chair and receiving treatment with curing light from crop doctor

Some plans do cover orthodontic services, but may exclude dental coverage for the alignment appliances themselves. This is something to keep in mind when choosing a plan.

Choosing a Delta Dental Exclusive Provider Organization (EPO) plan means you must select a dentist in their PPO network to receive full benefits.

Services performed by non-Delta Dental PPO dentists are not covered, so you'll pay out of pocket for these services.

Types of Insurance and Networks

There are several types of dental insurance plans, each with its own network of participating dentists. A Preferred Provider Organization (PPO) plan offers the most savings when you choose dentists in the nation's largest PPO network, where fees for services like routine checkups and fillings are lower.

You have the flexibility to choose any dentist you prefer, but choosing a PPO dentist will stretch your benefits further and leave you with more dollars for unplanned or emergency services throughout the plan year.

Patient having a Dental Treatment
Credit: pexels.com, Patient having a Dental Treatment

Prepaid plans, on the other hand, have a smaller network and provide no out-of-network benefits. You'll need to choose a dentist from the Care network when you enroll in your plan, and while prepaid plans usually have lower premiums, they offer lower reimbursement for services and don't cover services or treatment provided by out-of-network dentists or specialists.

Some plans, like the Delta Dental Premier plan, allow you to save money when you choose dentists in one of the nation's largest dental networks, but service fees may not be as low as PPO dentists. You may also need to pay coinsurance, which can increase what you pay out of pocket.

BlueDental plans, including PPO and HMO plans, have a provider network, which is a group of dentists that work closely with the dental insurer to provide services and treatment at a set fee. This network is usually at a reduced rate, and seeing an in-network dentist will help ensure you receive cost-effective, high-quality care.

Here's a breakdown of the different types of dental insurance plans and networks:

Annual Maximum

Focused dentist healing teeth of female client in clinic
Credit: pexels.com, Focused dentist healing teeth of female client in clinic

The annual maximum is a crucial aspect of your dental plan. It's the maximum dollar amount your plan will pay toward the cost of dental treatment or services during a calendar or plan year, which is typically 12 months.

This amount only applies to the portion your plan pays for services you receive, not to out-of-pocket costs like deductibles or copayments. Once you reach the annual maximum, any additional dental services you receive won't be covered until the next plan year.

To keep track of your annual maximum, you'll receive an Explanation of Benefits (EOB) statement each time you visit the dentist. This statement will show how much has been credited toward any required deductible or annual maximum.

Here's a breakdown of what you can expect to see on your EOB statement:

  • Any balance you’re responsible for paying the provider
  • How much has been credited toward any required deductible or annual maximum

Remember, it's essential to review your EOB statement closely and compare it to the receipt or statement from your dentist to ensure everything is accurate.

Blue Loyalty

Credit: youtube.com, Health Insurance 101: What is a Network? | BCBSND

Blue Loyalty is a program that rewards members for their loyalty. It's available to individuals who have an individual BlueDental Choice or Copayment plan, which they purchased themselves and not through an employer.

To be eligible, you must be over 18 and have one of these plans. The program kicks in after you reach certain membership milestones, starting at just six months.

As a BlueDental Loyalty member, you'll get extra services and benefits. These can include additional support and resources to help you manage your dental health.

Here are some benefits you can expect from BlueDental Loyalty:

  • Extra services and benefits to help you manage your dental health

These services can help you stay on top of your oral health and prevent costly dental problems down the line. By being proactive about your dental care, you can save money and reduce your risk of serious health issues.

Coordination of Benefits

Coordination of benefits is a crucial aspect of insurance that can save you money. You may have multiple dental plans, including BlueDental, that provide the same or similar benefits.

Credit: youtube.com, COB | What is Coordination of Benefits in medical billing?

If you have another dental plan, BlueDental will work with that plan to determine which one is the primary payer and which is secondary. This process is called coordination of benefits.

Other types of coverage that can be coordinated include group-sponsored insurance, non-group-sponsored insurance, other group benefit plans, Medicare or other government benefits, and dental benefits that may be included in your automobile insurance.

Frequently Asked Questions

What is basic in dental insurance?

Basic dental insurance typically covers routine services like oral exams, x-rays, and fillings, as well as preventive care like sealants and prophylaxis. This level of coverage is often the foundation of a dental insurance plan, providing essential care for maintaining good oral health.

What is the most dental insurance will cover?

Most dental insurance plans cover 100% of preventive care, including routine cleanings and exams. Basic care typically covers 100% of simple procedures like fillings and extractions.

What is not covered by dental insurance?

Dental insurance typically does not cover cosmetic procedures, such as teeth whitening and veneers, which are focused on improving the appearance of your smile

Krystal Bogisich

Lead Writer

Krystal Bogisich is a seasoned writer with a passion for crafting informative and engaging content. With a keen eye for detail and a knack for storytelling, she has established herself as a versatile writer capable of tackling a wide range of topics. Her expertise spans multiple industries, including finance, where she has developed a particular interest in actuarial careers.

Love What You Read? Stay Updated!

Join our community for insights, tips, and more.