The high cost of dental work is why millions of Americans delay their treatment each year. Dentistry is a booming industry, and no other field has seen so many advancements in such a short period for the benefit of both patients and practitioners alike. Modern dentists are staying up-to-date on the latest research, implementing new treatment methods daily, providing oral care to the highest standard, and utilizing groundbreaking dental equipment that aids in successful diagnostics and procedures. Long gone are the days when patients dreaded the dental chair and where visits often ended with tooth extractions. Current dentistry focuses on preventative and restorative oral care as long as you visit your dental home regularly.
Unfortunately, many people still struggle with showing up for regular dental appointments, despite research strongly indicating that bi-yearly checkups play a crucial role in preventing the development of major dental issues. Besides dental phobia, patients simply fear the cost of dental work. Others wait to finally get their dental coverage. How does dental insurance work, and is it worth getting one?
How Does Dental Insurance Work?
Dental insurance is supposed to have one job – to provide you with access to dental care in a worry-free and affordable way. Is that always true? We will explain the concept of dental insurance in two parts: one focusing on how your coverage should work (in a utopian sense) and the second on how dental plans really work (in a realistic sense).
Let’s cover (no pun intended) the basics of your typical dental insurance:
- Premium – as with your medical or auto insurance, you are required to pay a monthly premium for your dental coverage. That may happen through your employer if your work offers insurance for its employees, and partial costs will be deducted from your paycheck. If you shopped for dental insurance on your own, the monthly fees go directly to the insurance provider.
- Waiting period – if your oral health demands dental work that goes beyond preventative care, you may be required to wait up to six months before you can get your dental treatments.
- Primary dentist – your dental insurance may necessitate choosing a primary dental provider. They will be the ones where you can go for general dental care and, if need be, will organize any specialized treatments.
- In-network providers – your dental insurance plan might require you to seek dentists that are within your specific network. If that’s the case, you will need to avoid out-of-network dentists as the out-of-pocket cost might be much higher, or you might not be covered at all.
- The terms of coverage – your dental insurance plan will provide you with the nuts and bolts of your coverage, which will include the frequency and limitations of certain exams and procedures. For instance, you might be fully covered for your twice-a-year checkups with professional dental cleanings but have limitations in regard to fillings or root canal treatments. Studying your terms of dental coverage is very important.
- Deductibles – depending on your particular dental insurance plan, you might have a deductible, which is the portion you have to pay before the plan really kicks in.
- The extras – there are additional costs you might be responsible for besides deductibles. Many dental plans work on a coinsurance basis, where you and your insurance provider share the cost of treatments. This is usually calculated based on percentages, where your insurance might cover 80%, and you will be required to pay the remaining 20% of the entire bill. You might be presented with an annual maximum – most insurance plans will provide you with the amount they will cover yearly, usually excluding preventative exams. You might also be asked to pay a copay during each visit, which is essentially a small fee, often a fixed amount, expected to be paid at the time of a visit.
- Zero-cost preventative dental care – most dental insurance companies offer no-cost preventive exams twice a year as part of the coverage, including cleanings, routine checkups, and x-rays.
Dental Insurance Coverage Breakdown:
Each dental insurance plan has its terms and conditions regarding coverage based on the type of dental care. While you might get no-cost preventive exams, your restorative treatments will have out-of-pocket costs. Knowing what type of dental care you will most likely need will help you determine the right dental insurance. If you suspect your oral health is not in superb condition, or if you know for a fact that you will need dental crowns or root canal therapy, plan accordingly. Even though getting minor and major dental work might still include out-of-pocket costs or unexpected expenses, choosing a plan that can aid in financing your dental care, even if minimum, is essential.
Each dental plan has its own premiums based on the coverage you pay. Full coverage dental insurance is the best option for those requiring comprehensive dental exams and procedures to restore your smile’s health. It will, however, cost you much more. For those reasons, consider speaking with your dentist about a payment plan and calculate whether such extensive coverage is worth getting. You might be better off drafting an agreement between yourself and your dentist.
Now, How Does Dental Insurance REALLY Work?
To explain how dental insurance really works, we need to take a step back and determine whether dental insurance is, in fact, insurance. It might be worth getting dental coverage for regular dental care needs, depending on where you live and who you see. When dentists think of “dental insurance,” they usually have a prepayment option in mind. And that prepayment is for the most basic level of care. As you require more complex dental treatments, your coverage decreases accordingly. While a tooth crown or a bridge might be partially covered, many dental insurance plans do not even consider coverage for implants – a necessity for many patients.
Dental costs are not standardized. Your dentist signs a contract with a particular dental insurance provider agreeing to getting paid less for certain procedures. Knowing that, you and your dentist can come to an agreement on the whole cost of restoring your smile, which might be a win-win for both of you. Oxboro Family Dental is eager to make dentistry accessible to all, with or without dental coverage.