What to Look for When Choosing A Dental Insurance Plan
Open enrollment time is here, and everyone is looking at different insurance plans to determine which is the best for their needs. Dental insurance and the way it works is quite different from medical insurance. Here is an explanation from our Newport Beach dentist on how dental insurance works and some of the things you should look for when deciding which plan is best for you in the coming year.
The Yearly Allowance
The yearly allowance is the dollar amount that your policy will pay toward your dental expenses in a given year. Typically, the amount will be around $1,000 to $1,500, though some plans do offer a higher allowance. Once your policy has paid the amount that they set, they won’t pay another penny until the next calendar year rolls over.
Look to see how much your deductible would be. This is one of the key ways of how dental insurance works differently from medical. With dental, there’s a one-time deductible that you pay once per calendar year, the first time that you have dental work done that year. The amount you pay is typically between $50 to $100. The deductible doesn’t apply to services such as regular cleanings or exams, but comes into effect when doing an actual treatment like a filling, or crown.
The Calendar Year
The calendar year is the length of time that a group of benefits is valid. For example, if your 2020 calendar year runs from January to December, then that’s the period of time you have to use your yearly allowance. Some policies run mid-year to mid-year, so the calendar year is always something important to know.
Roll Over Amount
If you find a policy that lets you roll over unused benefits to the next calendar year then you’re in luck. This perk is very uncommon as most policies work under the “use it or lose it” rule.
If you do need dental work done, then your policy may pay a certain percentage of the cost of your treatment, meaning that your plan won’t pay their full allowance right off the bat.
Depending on the procedure that you need to have done, you can expect your dental coverage to pay about 50% of the cost of a crown or about 80% of a dental filling; it varies from plan to plan. The balance will be your co-payment. The exact percentages and figures will depend on the procedure or even the tooth that the treatment is being performed on.
Remember that when the plan pays its portion, it will only do so up to the yearly allowable amount. Any other fees will be your responsibility.
Most policies will help pay for a certain procedure to be done every so often. For example, if you have a crown placed and your policy paid their portion of it, it might be five years before you can claim another crown on that same tooth. There are also frequencies for cleanings which are usually two per calendar year, x-rays which vary between yearly to every three years depending on the type of image, and prosthetics like partials and dentures typically have a five-year replacement minimum.
If you put in a claim to have a repeated treatment and your policy has proof that it was already covered, then they’ll deny your claim and you’ll be responsible for paying the entire fee of your procedure.
Missing Tooth Clause
This is a very important clause to look for if you’re wanting to get dental coverage to replace teeth that you’re currently missing. What the missing tooth clause means is that if you lost a tooth during the time you weren’t covered under your current dental insurance plan, then the plan isn’t going to pay toward having the tooth replaced.
If your reason for acquiring dental insurance is to get your teeth whitened or have a makeover with porcelain veneers, then you likely won’t find a dental insurance plan that covers these types of procedures since they are considered cosmetic dentistry and not medically necessary.
Once upon a time, dental insurance policies refused to pay for dental implants claiming that they were a cosmetic dentistry procedure. However, most companies are starting to see the benefits of having a tooth replaced with a dental implant and are therefore helping to pay toward the cost. If you’re interested in having dental implants for your missing teeth, then you should make sure to see if they’re covered under the plan you’re considering.
Dentist in Newport Beach
When you get your new insurance set up, come see Dr. Yazdan, our Newport Beach dentist, for an exam. We’ll gladly discuss in detail the treatment that you need and answer all of your questions. We look forward to meeting you!
About Dr. Yazdan
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