Dental insurance can be a source of deep confusion for dental patients and practices alike. At our practice, we spend a great deal of time and energy working with insurance companies to maximize their customers’ benefits, and then in turn, educating patients about the total impact of those benefits to their family budgets.
In this post, we thought we’d share some common things that are true of many—but certainly not all—dental insurance plans. Dental plans can be complex, so we encourage everyone with coverage to review their dental insurance or benefits plan at least once a year.
Dental Benefits vs. Dental Insurance
About 2/3 of Americans have some form of dental coverage. Most people think they dental insurance, but what they actually have is a “dental benefits plan.” The difference between the two is pretty technical, but it’s mostly about how the risk of dental complications are managed and how the customer deals with the insurance company or plan administrator. For the sake of this post, we’ll just refer to dental coverage as insurance.
What Are the Different Types of Dental Insurance Plans?
When it comes to dental insurance, there are three basic types of plans:
- Preferred Provider Organization (PPO): In a PPO type of dental insurance plan, you are given a list of dentists who accept your insurance. You’re allowed to see a dentist for care who is out-of-network, but you’ll usually pay a lot more out-of-pocket.
- Dental Health Maintenance Organization (DHMO): A DHMO is similar to a health insurance HMO. With this type of dental insurance plan, you pay a premium and are able to see a network of dentist who accept the plan. You’re usually only charged a small co-pay or no fee at all, depending on the plan’s administrator.
- Fee-For-Service Dental Plans: These are sometimes called dental indemnity plans. With this type of insurance plan, you’re typically able to see a wide range of dentists. The cost of procedures is predetermined by the plan. You typically pay for a portion of treatment, and the plan pays the dentist’s practice the rest.
How Much Does Dental Insurance Cost?
According to market research, the average annual cost for dental insurance is about $200-$600. Plans vary by coverage and deductibles, which will determine the cost a person’s monthly premium. As far as out-of-pocket costs, these are the terms you need to know when you review your insurance plan:
- Annual maximum: Many dental insurance plans will only pay some much per year for treatment. Make sure you look at this or ask about it before purchasing any dental insurance plan.
- Co-pay: This is a small fee you usually pay for a visit to the dentist.
- Deductible: This is what you will need to pay before you plan “kicks in” and pays the rest for a procedure.
- Coinsurance: Sometimes procedures are priced this way with a dental plan, giving you a percentage or fixed amount you must pay after a deductible has been paid.
Thanks for Reading!
There’s a lot to learn when it comes to dental insurance, but we’ve got you covered. If you’re a new or existing patient and have questions about your dental insurance benefits, contact us and we’ll do our best to answer your questions.
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