How Does Dental Insurance Work?
Dental insurance policies are an effective way for many people to pay for and maintain a great smile. Often times policies are purchased by employers which can limit your options but can also be purchased as a standalone policy. Compared to medical insurance, understanding dental insurance policies is a piece of cake. Most policies are very clear and specific in which procedures are covered and exactly how much you have to pay out-of-pocket. With some basic information on your insurance policy and a free consultation, our team here at White Pine Dental can give a fairly accurate quote for what your insurance will cover and what you will need to pay out-of-pocket.
Dental Insurance Waiting Period
In order for insurance companies to guarantee a positive return, it is common for insurance agencies to have a waiting period of six to 12 months before any work can be done. For major work, this waiting period can extend out to two years. These wait periods discourage people from applying for a new policy to cover impending procedures.
Deductibles, Co-Pays, and Co-Insurance
A deductible is an amount of money set by the insurance company in your policy that shows how much one must pay out-of-pocket before the insurance company will cover any costs. This deductible amount usually resets at the beginning of the new year. If you reach your deductible limit your insurance should cover any additional costs unless you opted for a co-insurance policy.
Co-insurance is a type of shared risk policy for you and your insurance company. If you have an 80-20 policy, you will pay 20% of any additional expenses beyond your deductible while insurance pays the rest. There are often out-of-pocket max limits on how much someone can pay with a co-insurance policy.
A co-pay is a standard part of many insurance plans, it is a fixed out-of-pocket amount that is charged per visit. They are generally specific dollar amounts rather than a percentage of the bill and are usually paid at the time of the service.
Procedures Categorized by Dental Insurance
Dental insurance generally groups procedures into one of three categories: preventative, basic, and major. Most dental plans cover 100% of all preventive treatment, such as semi-annual or annual cleanings, X-rays, and sealants. These yearly preventive care visits are generally lost if they are not used during the year. Schedule your next appointment today to avoid losing them.
Basic procedures are treatments for gum disease, extractions, fillings, and root canals. Your cost for these procedures is determined by your co-pay, deductible, and co-insurance. Most policies cover between 70% and 80% of these costs while the patient pays the rest.
Major procedures include crowns, bridges, inlays, and dentures. These procedures are generally only covered with a high co-pay and more out-of-pocket expenses for the patient. However, it is important to recognize that every policy is different in how procedures are categorized and should be considered when comparing policies.
Dental Insurance and Cosmetic Procedures
It is common for insurance companies to consider cosmetic dental procedures as not medically necessary since the primary intent is to improve the look of your teeth and are often unwilling to pay for them. Some of these procedures include teeth whitening, tooth shaping, veneers, and gum contouring. Some policies cover braces but often will require additional insurance costs.
Similar to yearly out-of-pocket maximums on co-insurance policies, insurance companies often have yearly coverage maximums that they are willing to pay. These amounts typically range from $750 and $2,000 and generally have higher maximums as monthly premium amounts increase. Once the yearly maximum is reached, the patient must pay for 100% of any remaining balances for dental procedures. Roll-over programs are common to roll over portions of unused balances to the next year.
Using Tax Credits for Dental Insurance
Leftover tax credits not used to pay for your family's health insurance purchased through Healthcare.gov can be applied to pediatric dental insurance premiums if your medical insurance doesn't include dental coverage. If your health insurance policy includes children's dental coverage, you cannot use tax credits to buy an additional plan.
Do They Take My Insurance?
Every dentist will be able to work with different insurance companies so it is important to call ahead and check. Here at White Pine Dental, we are contracted with most PPO plans (Preferred Provider Organization Plans) and work with the large majority of insurance companies. We're here to help your receive the highest benefits from your insurance companies.
No Insurance? No Problem!
White Pine Dental offers affordable dental services that fit your needs. As an added bonus, we offer our White Pine Dental Savings Plan to non-insured patients to help with discounts and benefits. We offer multiple financing options to best serve you.
More Questions? Call us at 801.590.4721 or request an appointment to get answers and set up a complimentary consultation.