Protect Your Teeth: Understanding Dental Insurance

Posted on October 9, 2018

Over the years, many adults have decided to forgo dental work altogether.

There could be many reasons why, including price, anxiety, the perceived need for it, and much more.

It could be that people have a tough time understanding dental insurance.

If the price is the issue, then it would help to pull back the veil on dental policies and coverage, so to speak.

Let's first take a look at why dental work is important before we jump into dental insurance benefits.

Why You Should Care About Going to the Dentist

Don't let a lack of understanding dental insurance and policies keep you from going to the dentist. The first thing we need to stress is the importance of having regular dental work done in the first place.

If you're not taking advantage of dentist benefits, then you're causing your overall health to suffer.

While the debate rages over how often you should visit the dentist, the fact remains that it's still important.

The reason your oral hygiene is so important is that your mouth accumulates bacteria at a quick rate. And while regular flossing and brushing can help keep things under control, sometimes problems get worse.

Even with regular care (but especially without it), the activity of your mouth can lead to infections or even worse.

Poor oral health, such as infections and inflammations, can lead to heart diseases. Plus, if you suffer from other diseases and conditions, such as diabetes or HIV/AIDS, they can have severe adverse effects on your oral health.

Dentist visits are more than just a cleaning. It's more than making your teeth white. Your oral health and bodily health are closely tied.

It's no less important than going to your general physician for a checkup.

With that in mind, let's take a closer look at dental insurance and what it entails.

Understanding Dental Insurance

Before selecting dental insurance, it's important to understand dental insurance benefits.

There are a few different types and limitations. Therefore, it's impossible for us to be able to explain exactly every situation of every single dental insurance plan.

We'll try to keep it simple and talk in generalities that most likely cover most common dental policies.

Types of Dental Insurance

The two major types of dental insurance plans are Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO).

A PPO is a good balance between affordable price points and variety and availability of dentists. With a PPO you usually end up paying a percentage of a reduced rate for your visit, which is called a co-insurance.

Not only that, but you'll need to visit a dentist or dental facility that is covered under your specific insurance network. You can often get a doctor's referral for a dental specialist.

These types of plans are pretty standard and are often offered by employers automatically.

DHMOs, or dental HMOs, require you to pay a fixed amount, called a co-payment, and you must commit to your treatments being done through a single dentist.

The Wait Period

Believe it or not, there is a waiting period for your dentist benefits to start taking effect. This is usually six to 12 months and can take upward of two years. It depends on the coverage.

The reason for this is so that people don't seek out new policies just for upcoming procedures.

What is Covered

You have to look at the policy itself to know what is covered.

This can change from person to person and plan to plan. But there are a few "rules of thumb" to keep in mind if you need a general idea. So we'll try and keep it broad and cover the basics.

Usually, dental insurance benefits are grouped into three different categories. This includes regular work, critical work, and major work. The terms may change, but the principle remains the same: simple to complex work.

Regular visits might include teeth cleanings, checkups, or evaluations. These are usually diagnostic in nature, and dental insurance benefits cover about 80 percent or more of these regular visits.

Critical work includes things like fillings and may cover around 70 percent to 80 percent of the bill.

Finally, major work includes things like root canals and may only cover around half of the total bill.

You pay what is left over, which is the co-insurance payment.

All in all, most procedures will be covered under dental policies, but how much depends on both the insurance and the procedure itself.

What is NOT Covered

Again, you really need to check the specifics of the plans available to you. In general, cosmetic dental procedures are not included as dental benefits.

This includes the likes of teeth whitening or veneers. These types of procedures are chosen for personal reasons are not deemed medically necessary.

Therefore, you will often need to pay 100% of the cost of cosmetic procedures out of pocket.


We've covered co-insurance and co-payments, or the amount you pay to fill the gap of what your dental insurance didn't cover.

On top of this, you also have to pay a monthly premium (you may also have the option to pay your premium for an entire year all at once).

This is similar to general health insurance, as well. This is essentially the amount of money you're paying for the dental benefits to be covered. The higher the premium, the fewer limits and exclusions (more on that in a second).

Treatment Estimate and Plan

You can request a dentist to provide an estimate of a treatment plan.

Sometimes, the dental work you need is complex. You want to be able to plan ahead and see what out-of-pocket payments are going to be required.

This makes it easier for you to determine what kind of coverage is right for you, too.

Limitations, Maximums, and Exclusions

When understanding dental insurance, you should realize there are maximums and limitations to most, if not all, plans.

In general, there is a maximum amount of money a dental plan will pay for your procedures.

Again, it can change from person to person and coverage to coverage, but generally, speaking it can range anywhere from $750 to $2,000 annually.

Some plans may allow unused annual allowances to roll over into the following year, but some don't.

This is to prevent people from abusing policy coverage by visiting more than is necessary, but it's important to know what your limits are.

Not only that, not all plans are created equal and some plans may exclude certain procedures altogether. Again, the higher your premium and better your coverage, the fewer limitations and exclusions you'll experience.

Therefore, it's important to look over your prospective dental policies closely. If certain procedures are not covered under your policy and you end up needing them, you could be paying out of pocket.

This is why it's so crucial to read the policy booklet and plan for your future. Be sure to account for any possibility.

How Important is the Name?

Short answer: maybe not at all.

Somewhat longer answer: you have to look at the details of the policy closely first.

For example, what procedures are covered relative to the premiums you'd have to pay? How many dentists and dental facilities are included in that insurance plan's network? What kind of annual maximums and limitations might you have to deal with?

A well-known brand name insurance policy might be recognizable but it may not offer exactly what you're looking for.

Don't jump on something due to brand name alone, but shop around and make sure you're getting exactly what you need and what you're paying for.

It's OK to Shop

There seems to be this general idea and attitude about any kind of insurance--health, car, dental, etc.--that you have to just take what is given to you no matter what.

Maybe you don't even want to think about it, so you just jump at the first plan that's offered to you.

Don't be afraid to shop around when you're browsing dental policies. Ask your general practitioner for some guidance, talk to friends and family to see if they are happy with their coverage or not, etc.

Weigh the pros and cons of all the plans you come across. Make a physical list if you have to!

Even though insurance is often necessary and not something we like spending money on, don't be afraid to treat it like any other purchasing decision. It's an important one to make, so be well-informed.

Making the Best Choice in Dental Insurance

Most people don't like the dentist; that's no secret. But as we've already covered, you should understand the importance of dental health in the first place.

Understanding dental insurance is a key aspect of improving your oral health. If you can't grasp the details of dental policies and dental insurance, then how will you know how to proceed?

Hopefully, you learned a bit to today about how dental insurance works. If you'd like to learn how to save money on your dental insurance, check out our post here!

Next Post:
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram