Dental Insurance: Description Of Dental Insurance

A visit to the dentist can be painful and can induce anxiety, especially if you have ever been faced with a bill without dental insurance. There are many different types of dental insurance available to you in a variety of ways, including through your employer or directly from an insurance company as an individual.

Dental insurance can also be available through other channels. Organizations such as business groups, college alumni or fraternities, or religious groups can have dental plans available to their members. Also, the AARP offers dental insurance to its members.

DHMO, the Dental Health Maintenance Organization, provides the least expensive coverage. Under this plan, specific dentists have agreed to perform certain treatments for a small co-payment and even at no charge.

Indemnity insurance will pay a portion of the dentist fee either to you or directly to your dentist. This type of insurance can have a higher premium and usually requires you to pay your dentist first and then submit your bill for payment.

PPO, the Preferred Provider Organization, has a list of preferred dentists who, in exchange for being referenced by the PPO, have lowered their fees. Your dental insurance will allow you to visit a dentist that is not on the list; however, you may end up paying higher deductibles and co-payments. A list of PPO dentists in your area is provided to you by your insurance company, either by mail or on their website.

Scheduled dental insurance follows a UCR, Usual Customary and Reasonable, fee guide from which your insurer will pay you a fixed amount for each procedure. However, if your dentist charges more than what is quoted on the UCR, you can be responsible for the balance. Some dentists waive the difference and some do not.

Some insurance companies offer discount cards you can use if your coverage does not adequately cover your needs or if your dental insurance does not cover a certain procedure.

Dental insurance plans are not all created equally; some will offer a wider variety of coverage. Some dental insurance coverage has limits and omissions, such as indemnity waiting periods on certain procedures, and the missing tooth clause, meaning your insurer will not cover the replacement of a tooth that was missing previous to your policy.

Dentist fees are very expensive and with dental insurance, you, like most Americans, can afford to keep you and your family’s teeth healthy.

Dental Insurance: Description Of Dental Insurance

Dental Insurance: What Does Dental Insurance Cover?

Dental insurance will help cover your expenses, even when your dentist says your daughter needs braces. There are three general levels of insurance most insurers follow and each contains certain procedures that are included: preventative, basic or major.

Preventative dental work is usually fully covered. Most insurance companies believe in preventative measures for dental health. Therefore, most policies will include two free check-ups per year. Your biannual freebies usually include:

  • A cleaning to remove built up tartar at and above the gum line, a simple procedure that can prevent very serious tooth and gum damage.
  • X-rays and an oral examination of your teeth can discover issues above and below the gum line and preventive measures can be taken before they become serious.
  • A fluoride treatment to help fight tooth decay.
  • Some dentists will even throw in a new toothbrush and dental floss for you to take home.

Basic or restorative dental work in this category can require you to pay a deductible or co-payment:

  • Fillings for cavities to prevent further decay and for minor repairs to a tooth.
  • A root canal procedure if a tooth can be saved with some restoration.
  • A tooth extraction to remove a severely damaged tooth and prevent infection and decay in neighboring teeth.
  • Treatments for periodontal diseases, such as gingivitis.
  • Emergency dental procedures.

Major dental procedures are much more extensive and will have less coverage than the previous two categories. You may also be required to wait for a certain period of time before you can receive reimbursement from your dental insurance; your waiting period can be up to one year.

  • A crown, or cap, is a common way for your dentist to rebuild and strengthen a weakened tooth.
  • Dental bridges to span a gap made by a missing tooth.
  • Dentures, to replace a large number of missing or damaged teeth at one time.
  • Oral surgery to repair mouth injuries and defects.
  • A dental implant of a false tooth.
  • Orthodontia for straightening teeth.
  • Cast restoration, using a wax casting of your teeth and gums for restoration.
  • TMJ, temporomandibular joint dysfunction.
  • Chronic gum disease.

A toothache can be very painful and so can extensive dental work. Using dental insurance will help you afford, and even avoid, both scenarios.

Dental Insurance: Costs Of Dental Insurance?

Dental Insurance: What Does Dental Insurance Cover?

Tooth decay, disease and injury are common occurrences and most can be prevented easily and affordably. There are three categories of dental coverage: preventative, basic and major.

  1. Preventative dental work usually has 100 per cent coverage. This is because it is proven that regular visits to the dentist to receive an examination and x-rays, a cleaning, and a fluoride treatment can prevent the majority of tooth decay and gum disease.
  2. Basic or restorative dental work is more extensive and is for the repair of damaged teeth, such as fillings, tooth extraction, and the treatment of gum diseases, such as gingivitis. You may incur the cost of a deductible or a co-payment for these types of procedures. Most dental insurance plans will cover between 70 percent and 100 percent.
  3. Major dental work is very intrusive and usually consists of the complete removal and replacement of a tooth or a number of teeth. This includes prosthetics such as crowns and bridges. Braces and other orthodontic work are also in this category. Your dental insurance deductible or co-payment can be as high as 50 percent of the cost.

A dental discount card can reduce your dental costs by 25 to 60 percent. The dental discount program is not dental insurance. For a low monthly fee, you become a member and you are provided with a list of participating dentists that will give you a discount on your dental work. This card is most beneficial to people who do not have dental insurance or have an insurance policy that does not cover certain procedures. Most cosmetic work is not covered by dental insurance; however, you can receive a discount through the discount card.

Applying for dental insurance through your employer can also reduce your costs. Employers, such as the U.S. federal government, can get a group dental insurance plan at a very low cost. It is up to the company to decide your share of the premium, which is, on average, $50 per month. This amount can be much lower than individual insurance premiums which can be about $200 per month.

Most dental insurance policies will cover between $1,000 and $1,500 per year in dental costs. This amount depends on how many people are on your policy and where you live. In some instances, your dental insurance premiums can be tax deductible.

Keeping you and your family’s teeth healthy can prove very expensive without dental insurance.

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