How does Dental Insurance work?

How Dental Insurance Works

One of the most common misconceptions about dental insurance is that it works the same as medical insurance. Dental insurance is separate from medical benefits and has its own rules and regulations.

The most important thing to understand about your dental benefits is that there is a covered percentage of the allowed amount of procedures performed.  The covered percentage can be anywhere from 20%-100% of the allowed amount. The allowed amount is the amount that the insurance provider will pay of the fees from the doctor. For example, let’s say that the fees from the doctor are $1000. The allowed amount by your insurance provider is $700 dollars, and the covered percentage is 80%. This means that the benefits paid by your insurance provider will be $560, because the benefit is 80% of $700.

Also, it is important to note the yearly maximum for your plan. Once you reach the maximum for your plan, you will not receive any other benefits until the next policy year. This is different from medical insurance, where once you have paid your deductible & out of pocket maximums, you will have full coverage for the rest of the year. Most larger treatment options for dental work will max out your plan for the year. If you know you have substantial dental treatment coming, you will be better off planning on paying most of the costs out of pocket, so that you will not be surprised when the dental benefits are not covering the work.

It is best to read and understand any restrictions or limitations of your plan. Not all dental treatment is covered by dental insurance, and the coverage is different plan to plan. Some plans have a Least Expensive Alternate Treatment clause, which means that if the insurance feels that a less expensive treatment could have been performed, you will only get the benefits for that treatment.

Overall, if you look at your dental insurance as a benefit, as opposed to true insurance, you will have less surprises and will be better prepared when working with different offices.

Recent Posts