Did you know that approximately 77 million Americans have dental benefits? Most people have private coverage through an employer or group program. Since dental insurance doesn’t work the same way as a typical medical insurance plan, it can be confusing to navigate at first. To fully maximize your coverage, it pays to know a few things about your plan. Read on to learn about the most common types of dental insurance plans and what you can expect yours to cover.
What Are the Different Types of Dental Coverage?
There are a few different types of dental plans out there. Here are the most common ones that are available:
- Dental Health Maintenance Organization (DHMO): With this insurance plan, your insurance provider will give you a list of dentists that will accept your plan for a set co-pay or no fee. However, you won’t receive any coverage if you see a dentist that’s not on this list of in-network dentists.
- Preferred Provider Organization (PPO): A PPO plan gives you the option to choose whichever dental provider you’d like. You will still have a list of dentists that are in-network with your plan, but you can pick one out-of-network as well. However, if you decide to do this, you are more likely to end up with higher out-of-pocket costs.
- In-House Dental Plan: This is not a dental insurance plan, but it can work as an alternative. This is a plan that is offered directly by the dental practice that allows you to save on certain treatment options, usually for an annual fee.
What Do Dental Insurance Plans Cover?
Most dental insurance plans follow a 100-80-50 coverage structure. This means that they will cover the following dental treatments and procedures:
- 100% of Preventive Care: This includes regular cleanings, checkups, routine X-rays, and more.
- 80% of Basic Procedures: Basic procedures include fillings, gum disease treatment, and other non-invasive procedures.
- 50% of Major Procedures: Things like root canal therapy, dental implants, dental crowns, and orthodontic treatment often fall into this category.
It’s important to keep in mind that all plans are a little bit different, so it’s important that you do your own research before committing to a treatment. No one wants to be surprised by a hefty bill that they need to pay out of pocket!
The year is coming to an end, and your unused benefits will not be carrying over to 2023. If you need dental treatment or it’s been a while since your last checkup, there’s no better time to schedule an appointment. This way, you won’t need to worry about your deductible until later on. Use your benefits before you lose out on them!
About the Author
Dr. Benny Tong earned his dental doctorate from the Buffalo School of Dental Medicine before attending the NYC residency program at NYU-Winthrop University. He is committed to continuing education and is currently a proud member of the American Dental Association. For more information on dental insurance or to schedule an appointment at his office in Long Beach, visit his website or call (516) 431-5855.