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Understanding Your Dental Insurance

Dental insurance is one of the most misunderstood insurance benefits, the reason is that it works completely opposite of traditional medical insurance, which is more utilized so is more often our frame of reference. 

How many times have you attended an annual benefits meeting with the Human Resources department of your company and heard the phrase “and with your dental insurance you will get two free cleanings every year,”?  This is sometimes the case, but more often than not, it is really not how your plan operates.  So let’s take a look at how traditional dental insurance works so you can understand what you are really paying for each month.
 

Understanding Your Dental Plan

With a very standard dental plan, your family members may have $1500 of dental benefits available to them for use each year.  What that means is that EACH family member has $1500 to use for dental treatment, and while one family member may use all of their benefits in a year, that doesn’t take away any benefits that are available to other family members on the plan.  In that $1500 dental benefit, your periodic exams, cleanings and any xrays come off of those benefits.  So if you come to see the dentist in February and the cost of that visit is $250, you have $1250 remaining for the rest of the year.  Let’s say that your dentist said that you needed to have two crowns done and the cost of those crowns will use all of your remaining benefits for the year.  Now when you come in for your second cleaning in August, the cost of your cleaning and exam will be 100% out of pocket for you; now remember those two free cleanings your HR department told you about?  Well now you are not eligible for a second free cleaning because your benefits are gone until January if your benefits renew at the beginning of the year. 
 

Dental Plan Extras

Sometimes your company will offer you an option of choosing from more than one dental plan.  You may want to consider the needs of your family members and compare the cost of the plan to make sure the benefit is worth the extra money.  If you have teenagers at home you may want to look at a plan that offers orthodontic treatment benefits.  If your plan offers $1500 in orthodontic benefits that is a ONE TIME payout per member as long as you are on the plan.  This $1500 benefit is in addition to the $1500 that each member has for their exam, cleaning, xrays and other dental treatment. 

If you have missing teeth and want to restore those teeth with an implant or a bridge, you may want to ask if your insurance plan has what they call a missing tooth clause.  If they have that clause, what that means is that if you have a missing tooth BEFORE joining the plan, unfortunately they will not cover the cost of restoring that tooth.
 

PPO Plans vs HMO Plans

When choosing your plan, you may want to ask yourself if you typically like to choose where you go for your care.  If you want to be able to go wherever you want for dental care, then choose a PPO dental plan.  For any medical or dental health plan, if you have HMO or DMO insurance, your plan will give you a list of where you may go for treatment and you can only choose someone from that list. 
 

Plans Accepted at Advanced Dental Health

Advanced Dental Health accepts all major insurance plans such as Delta Dental, United Healthcare, Cigna, MetLife and more as long as they are PPO plans.  We do not accept HMO, DMO or state Access plans. 
 

New Dental Insurance

If at any point in the year you get new insurance, it is always helpful to give our office a call so that we can verify your benefits before you get to your appointment so we can give you more accurate benefit information.  If you bring your dental card with you to your appointment, we can’t guarantee that we will be able to get your updated benefited information by the end of your appointment.
 

I’m always happy to answer any insurance questions that you may have about your insurance and I spend a lot of my time trying to get your insurance claims paid, even though your dental insurance may not want to!   My co-workers tell me that I’m crazy because I honestly LOVE working with insurance!
 

Stephanie Kraniak, Insurance Coordinator

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Understanding Your Dental Insurance

Understanding-Your-Dental-Insurance