What is Dental Insurance?

Dental insurance is a type of insurance that can help cover the costs of dental care and procedures. Having dental insurance can help alleviate the financial burden of costly dental care services. Dental insurance plans typically cover routine preventive services, such as check-ups, exams and cleanings, as well as basic and major dental procedures.

The Benefits of Dental Insurance

Cost Savings: Dental care can be expensive, especially when it comes to more comprehensive dental procedures. Having dental insurance can help you save hundreds and even thousands of dollars on covered dental services. 

Promotes Dental Health: If you have dental insurance, you are more likely to schedule and follow through with preventive care. Routine dental services, including exams and cleanings, help identify and treat oral health concerns before they become more significant and costly issues.Financial Protection: Unexpected dental services can be exceptionally expensive. By having dental insurance, you can have some peace of mind with the financial protection it provides when unforeseen dental issues arise.

Dental Insurance Glossary

Accepted Fee: The amount a dental provider agrees upon as full payment for a service or procedure. The payment can be from both the patient and the insurance company.

Annual Maximum: The full benefit amount that a dental plan will provide for services within a benefit period (such as a calendar year). The patient will be responsible for paying any costs exceeding the maximum amount of the dental plan.

Allowable Amount: The highest amount a contracted in-network dental provider can charge for covered dental services. 

Balance Billing: The difference a dental provider may bill you for their charged rates and the allowed amount. This most often occurs when a dental provider is not in-network with the insurance company.

Coinsurance: An amount you may be required to pay as your share of the cost of services after the deductible. It is usually a percentage.

Co-pay: The amount you pay for a dental service. It is usually a fixed dollar amount.

Cost Sharing: The amount a member is responsible for paying, such as deductibles, co-pays, coinsurance and other amounts.

Covered Benefits: The dental care and services that the insurance company will pay on and the predetermined coverage provided. 

Deductible: The amount you pay for dental care or before your dental insurance plan begins to pay.

Explanation of Benefits (EOB): A detailed notice members receive from the dental insurance company summarizing services received, what was covered by insurance and what the member’s responsibility may be.

Premium: The amount you pay the dental insurance company – typically once per month or once per year – in exchange for your dental insurance policy coverage.Waiting Period: A set amount of time, most often between 6-24 months, that a member must be enrolled in an insurance policy before the plan will provide coverage on specific dental procedures, most commonly major restorative dental services.

What Does Dental Insurance Cover?

Dental insurance plans typically cover preventive services, such as routine check-ups, exams and cleanings. Most plans will cover two preventive visits a year, although some may cover additional. Dental insurance plans may also cover basic and major dental procedures, including fillings, extractions, crowns, and root canals. Some dental insurance plans may even cover a portion of orthodontics and prosthodontics, such as implants, bridges and dentures. Many options are available for dental coverage, and what is ideal for you will depend on numerous factors. It’s important to note that dental insurance plans may have limitations, such as waiting periods and annual maximums. There may also be some procedures that are excluded. When selecting your dental plan, you’ll need to carefully review the coverage details to ensure it provides the benefits you are looking for.

Types of Dental Services

The types of dental services covered by dental insurance will vary from insurance company and policy. What is covered under each category, the percent it is covered at and the limitation of how much is covered will be unique to each plan. Here is a general guideline of the different types of dental services and how dental insurance plans may cover them. 

Preventive dental services such as routine exams, cleanings, checkups, x-rays. These services are typically covered up to 80-100%, with no waiting periods.

Basic dental services such as fillings and extractions. Most dental plans will cover basic services up to 50-70%. There may be waiting periods, and the covered amount will be subject to plan annual maximums.

Major dental services include crowns, implants, wisdom teeth removal, complex extractions, oral surgery, and dentures. Some dental insurance plans may exclude these services. Plans that cover major restorative dental services generally provide coverage up to 20-50%. There may be waiting periods, and the covered amount will be subject to plan annual maximums.

Related: Are Dental Implants Covered by Medicare? 

Some standard exclusions with dental plans include cosmetic procedures and pre-existing conditions.

Types of Dental Plans

Discount Plan

A dental discount plan is not a true dental insurance policy and operates more as a type of membership. The membership provides members savings on dental services. Instead of paying monthly premiums like you would with traditional dental insurance, enrollees pay an annual fee upfront. After joining, members receive a discount card and to receive a discount, you’ll need to go to a select network of participating dental clinics. Discounts vary depending on the selected plan, dental location and services needed. Discount plans differ from traditional dental insurance; although they can provide some cost savings, they are not the same as dental insurance and may not be the right choice for everyone.

‘In-House’ Dental Plan

Many dental clinics will offer an in-house dental program to clients. This type of plan is also not to be considered a dental insurance policy. ‘In-House’ dental plans can help those who do not have dental insurance coverage. How it works: for a predetermined dollar amount, you can expect 1-2 cleanings, exams and possibly x-rays in a calendar year. The dental office may also provide other benefits, such as one emergency visit or a percentage from non-preventive services needed.

Stand-Alone Dental Plans

A stand-alone dental plan is a dental insurance policy you acquire from an insurance company that provides coverage plans in your area. A stand-alone dental plan can be purchased separately from other coverage, such as health insurance. This type of dental insurance can cover individuals, couples, or families. Stand-alone dental plans are available from many insurance companies, and they can provide a wide array of coverage options, varying from preventive-only coverage to more robust and comprehensive benefits.

Embedded Dental Plans

Some types of dental insurance may be embedded or part of another plan. This can be the case for individual, family, or group health insurance as well as many Medicare Advantage plans (MA/MAPDs). The benefits of embedded dental insurance can vary significantly from plan to plan. Some provide preventative care only, while others have more comprehensive coverage, or there may be an annual allowance for dental services.

Related: Dental Coverage for Medicare Recipients

What to Consider When Choosing Dental Coverage

What is the premium of the plan?

Consider the monthly premium of the dental insurance plan you select. Is it affordable, and does the amount you pay monthly to have the plan provide adequate benefits for your needs?

Does the plan have waiting periods?

If your main reason for obtaining a dental insurance plan is to provide coverage for an upcoming procedure quickly, you may be disappointed to find out there are waiting periods on some benefits. Closely review the plan details to ensure it meets your expectations.

Does the plan cover periodontal cleanings?

Some individuals may need cleanings beyond a basic routine dental cleaning, such as periodontal cleaning, which is more comprehensive and costly. If this is the case, you should check that your dental insurance plan covers this service.

How much coverage is provided for major restorative work, such as crowns and implants?

The coverage and cost-sharing for major restorative dental services will vary from plan. Some provide no coverage, and others will pay anywhere from 20-50% of the costs depending on the service. Knowing what you need from your plan and how much coverage it provides will help ensure you choose the right plan. 

Is your current dentist in the dental network covered by the plan?

If you are not willing to change dentists, you should check in advance that your dental insurance plan has your dentist in-network so you receive the plan benefits in full.

At Twin City Underwriters we work with several different dental insurance companies to provide you with options. Having a plan in place for basic services like cleanings and exams, as well as more extensive services such as fillings and crowns, will provide you with peace of mind if and when these events occur.

At Twin City Underwriters, our licensed agents help you determine the ideal plan for your individual needs. All dental insurance plans offer different benefits, levels of coverage and utilize unique networks; with this in mind we work with you to ensure the plan you choose provides suitable coverage. For more information or to get a quote give us a call at 651-444-1190 or email us at info@tcunderwriters.com.