Three Important Details To Know About Your Dental Coverage

| September 20, 2013

Would you rather endure a toothache than try to decipher a dental insurance plan filled with mysterious acronyms and abbreviations?

You’re not alone. Nearly 40 percent of American adults hadn’t seen a dentist in the last year according to 2011 data from the Centers for Disease Control and Prevention, even though some had dental insurance. But regular visits to the dentist are important your overall health as well as your smile, and dental insurance can make many common procedures more affordable. Here are three tips to help patients decode the dental insurance they already have or decide which dental coverage is right for them:

Know the Difference Between PPOs and HMOs

Knowing the difference between Preferred Provider Organizations and Health Maintenance Organizations will help you discover the coverage that’s right for you.  You’ll pay higher co-payments and deductibles for a PPO compared with an HMO, but PPOs tend to have larger networks and make it easier to get out-of-network care, according to Consumer Reports. With an HMO you will have more limited options for out-of-network care than with a PPO, but you will generally pay less out-of-pocket, especially if you stay within the plan’s network of dentists. Make sure you know which system your dental insurance uses and, if offered a choice, investigate the best option for you before enrolling in a plan.

Know What’s Covered

Plans typically cover a set percentage of the cost of common procedures such as cleanings or fillings, but may not cover some conditions such as replacing a tooth that was missing before your insurance took effect. Understand what your plan covers before getting treatment and ask your dentist to check with your insurer first if you aren’t sure about a particular procedure or if you expect to have extensive treatment.

Be Aware of Maximum Benefits

Most plans have limits on the number of cleanings or routine exams you can get per year as well as the overall dollar amount they will pay out. Since many dental insurance policies are designed to encourage preventative care rather than cover costly procedures, your plan’s annual maximum payout might be fairly low – say $1,000. It’s crucial to know your plan’s limits, especially before getting any major dental work done.

Start by reading the dental insurance information provided by your employer to learn the basics.  Our friendly staff at Grandview Dental is happy to help you understand what costs will be covered by your particular plan, and the costs for which you’ll be responsible.