The In’s and Out’s of Dental Insurance

The In’s and Out’s of Dental Insurance

From a young age, we’ve all been told to brush and floss our teeth. Aside from keeping them white and preventing cavities, oral hygiene is so important for our bodies. Research has shown that the failure to maintain good oral health can lead to a diminished quality of life and potential medical complications like heart disease, respiratory diseases, Alzheimer’s, malnutrition, and may even cause low birth weight or premature births.

If you’re one of the millions of people who doesn’t have dental insurance through an employer, continue reading to learn more about dental health care and why it’s something you should consider to help keep you healthy.

dental health care

What is dental insurance?

Dental insurance helps to pay a portion of the costs associated with preventive, minor, and some major dental care. Dental insurance is similar to other insurances because you pay a premium and obtain coverage based on that premium. Once you pay your monthly premium, you will also need to pay a certain amount of out-of-pocket costs before your insurance plan starts paying. This out-of-pocket cost is your deductible. For example, if your deductible is $300 and you have a procedure that costs $215, your insurance will not pay for it. You must wait until other procedures are done that gets you to the $300 mark. After your deductible is met, your insurance will start to cover some of your dental costs. Most dental plans have a maximum amount that they will pay out each year. Additionally, there may be a copay required for your visits.

Differences between preventative, minor and major dental care

Preventive dental care is the semi-annual or annual visits to the dentist, which include teeth cleaning, x-rays and sealants. Many dental plans cover 100% of these procedures.

Minor dental care typically includes procedures like cavity fillings, root canals, and treatment for gum disease, among other things. After deductibles have been met and copays have been paid, dental plans may cover up to 70-80% of the cost of these procedures. You would be required to pay the remaining balance.

Major dental care includes crowns, bridges, dentures, and more. These treatments may be partially somewhat covered with a higher premium and copay.

What’s the waiting period?

Depending on which insurance carrier you select, a waiting period for dental insurance may be required. Preventive dental care, as described above, usually does not have a waiting period, so you are able to receive that treatment immediately upon purchasing coverage. However, some carriers may have anywhere from a 3-12 month waiting period before minor and major treatments will be covered. These waiting periods are put into place to prevent people from buying dental insurance right when they need a procedure done, and then cancel it after it’s paid.

In-network vs. Out-of-network

Something to consider, especially if you already have an established history with a dentist, is whether or not your dentist is in the dental insurance provider’s network. There is one main difference between in-network and out-of-network dentists.

In-network dentists usually negotiate with your insurance provider to offer lower rates on services, so you pay less if you choose an in-network dentist.

Out-of-network dentists, since they have no negotiated with the insurance agents, can charge you for any remaining amount after your copay, even up to the full billed amount.

Additionally, if your dentist is in-network, he/she will submit your claim to your insurance carrier for you, saving you a lot of time and hassle.

Dental insurance vs. health insurance

A frequently asked question is, “Does health insurance cover dental procedures too?” The answer is, yes and no. This is where it gets tricky and you must do your own research. Dental insurance can be purchased as a stand-alone coverage, which means it is one insurance policy strictly for dental work. In this case, if you also wanted to purchase health insurance, you would need to purchase a separate health insurance policy. However, some health insurance policies also include dental insurance. According to healthcare.gov, dental coverage is “an essential health benefit for children”. Therefore, if you’re getting health insurance for children under 18 years old, dental insurance must be available for them through either a health insurance plan or as a stand-alone plan.

Unfortunately, the government has not determined dental insurance an essential health benefit for adults and therefore, insurance companies are not required to offer dental insurance to adults. With this being said, no matter who you purchase your insurance from, make sure you get the coverage you need, whether it’s a stand-alone policy or part of a health insurance plan.

Is dental insurance really necessary?

There are certainly a number of benefits of dental insurance, with the main one being that it gives you access to more affordable dental care. On average, Americans spend approximately $360 a year for dental insurance.

If you take pretty good care of your teeth and only need to get your semi-annual cleanings, maybe you’re better off paying the out-of-pocket cost for those cleanings and not getting dental insurance.

However, any procedures other than annual cleanings can start to get pricey. For example, the average cost of a crown is between $750 and $1200 per tooth. Something else to keep in mind is that your teeth age just like the rest of your body and while you may take great care of your teeth now, that doesn’t guarantee that you will remain free of major dental work as you age. It also won’t prevent accidents from happening, and you don’t want to wait until it’s too late to have the coverage you need.

Before purchasing dental insurance, make sure you consider the information above. Maybe you need dental insurance, or maybe you don’t. Should you purchase it by itself or as part of a health insurance plan? Only you can answer that, but if you have questions, we are here to help. If you’re looking for affordable dental insurance, SafeAuto has got you covered through our partnership with Auego Benefits. Stay healthy!