Should you buy dental insurance?

Paying for the dentist is a big problem for many families. Dental insurance can be a great option to ensure you and your family always get the dental treatment you need.

With the rising cost of seeing a dentist, many people are struggling to get dental insurance. Whether you’re considering buying dental insurance through your employer or independently, be sure to research several different plans and ask questions about a number of factors, including network policies and types of coverage. This information will help you choose the correct dental insurance plan before signing on the dotted line.

Affordability and Annual Maximums

The annual maximum is the maximum amount a dental insurance plan will pay in a full year. The annual maximum will automatically renew each year. If you have unused benefits, those benefits will not be rolled over. Most dental insurance companies allow up to $1,000 to $1,500 per year.

In and out of network dentists

Most stand-alone dental insurance plans will only pay for your dental services when you visit a dentist who is contracted and participating in the network. Find out if you need to see a participating dentist, or if you can choose your own. If the plan requires you to see an in-network dentist, ask for a list of the dentists in your area that are contracted with them so you can decide if they have one that you would consider going.

If you wish to stay with your current dentist, some policies allow you to see an out-of-network dentist, however, the covered costs may be significantly lower.

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UCR (usual and reasonable)

Almost all dental insurers use what’s called the Usual, Customary and Reasonable (UCR) fee guide. This means they set their own price for every dental procedure they cover. This is not based on what the dentist actually charges, but what the dental insurance company wants to cover. For example, your dentist might charge $78 for a tooth cleaning, but your insurance company will only allow $58 because that’s the UCR fee they set.

If your policy requires you to go to a participating provider, you should not be charged the difference between these two prices. Contracting dentists usually come to an agreement with the insurance company to write off the difference in fees. If your policy allows you to visit a dentist or a pediatric dentist of your choice, check the insurance company’s UCR fee guide with what the dentist charges. You may have to pay the difference out of pocket, however, you can’t put a price tag on quality dental care.

Cover type

According to most dental insurance companies, dental procedures fall into three categories:

  1. Preventive: Most insurers consider routine cleanings and inspections as preventive dental care, however, X-rays, sealants, and fluoride can be considered preventive or basic, depending on the insurer.
  2. Basic or Restorative: Basic or restorative dental treatment usually consists of fillings and simple extractions. Some insurance companies consider a root canal essential, while others list it as primary.
  3. Specialties: Crowns, bridges, dentures, partial dentures, surgical extractions, and dental implants are some of the dental procedures that most dental insurance companies consider to be major procedures.
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Since all dental insurance companies are different, it’s important to be clear about which dental procedures fall into each specific category. This is important because some insurance plans do not cover the main procedure, while others have waiting periods for certain procedures. If you know you will need major dental work that is not covered by a particular plan, you should probably look elsewhere to find a job that fits all of your needs.

waiting period

The waiting period is the length of time the insurance company makes you wait after you get coverage before they pay for certain procedures. For example, if you need a crown and the policy has a waiting period of 12 months or more, you will most likely have paid the crown between the premium and the waiting period.

Missing Tooth Clause and Replacement Period

Many dental insurance policies have a “missing tooth clause” and/or a “replacement clause.”

A missing tooth clause protects insurers from paying for replacement of missing teeth before the policy is in effect. For example, if you lose a tooth before coverage begins and later decide to have a partial, bridge, or implant, you won’t have to pay for that service if the insurance company has a missing tooth provision in the plan.

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The replacement clause is similar, only the insurance company will pay for procedures such as replacing dentures, partial dentures or bridges after a specified time limit has passed.

Cosmetic Dentistry and Dental Insurance

Cosmetic dentistry is any type of procedure performed for vanity purposes only. Teeth whitening is very popular. While the results are excellent, keep in mind that the vast majority of dental insurance companies will not pay for cosmetic dentistry.

all covered

Before deciding to purchase dental insurance, discuss your treatment plan coverage with your dentist. In this way, you can decide whether it would be better to have dental insurance. A very important factor to remember about any dental insurance plan is that dental insurance is completely different from medical insurance. Most dental insurance plans are designed to cover only about $1,000 to $1,500 per year of basic dental care (roughly the same amount that was covered 30 years ago) and are not designed to provide comprehensive coverage like Medicare.

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To help fund your dental care, many dental offices now offer interest-free payment plans, knowing that dental insurance only pays a fraction. Remember, dental insurance is very different from medical insurance, and it’s important to discuss with your dentist what option is best for you before starting any new treatment plan.