People often put dental insurance on the back burner. It’s not required, money may be tight, and you’ll probably be fine without it, right?
Next thing you know, you skip a regular dentist appointment to avoid paying high out-of-pocket costs. Then, you miss another appointment and another, and before you know it, it’s an excruciating toothache that gets you in, and now you’re looking up how to get dentures in Utah.
Regular visits to your Utah family dentist are crucial for avoiding emergency situations. With routine six-month check-ups, your dentist could have caught that initial cavity and filled it in.
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Your oral health directly correlates to your overall health and well-being. With regular dental appointments a must, it is vital to understand the value of dental insurance. Are you wondering what insurance would cover? How it all works? Let’s drill in a little deeper to get a better idea.
Dental Insurance Coverage
Of course, all dental plans vary. What your plan covers depends on whether your dental care is considered preventative, basic, or major. Most dental insurance plans cover preventative services entirely. Preventative care includes x-rays, checkups, and cleanings. Depending on the plan, it could also cover a percentage of other services.
Many insurance plans have a 100-80-50 policy. The policy breaks down like this:
- 100% preventative dental care coverage
- 80% basic dental care coverage
- 50% restorative dental care coverage
Dental insurance plans usually also have a maximum amount they will pay toward your dental care each calendar year. This number differs based on your insurance plan, but a typical number might fall between $1,000 and $2,000.
Since plans vary so much, look into your plan and all the details. Know your benefits.
How Insurance Covers Different Services
Let’s start with routine dental care. In the best-case scenario, you take excellent care of your teeth, hardly ever have cavities or dental issues, and all you need are bi-annual dental checkups. The best way to avoid restorative or major care is to keep up with preventative care. However, if you do need care beyond routine checkups, your dental insurance is there to help.
Preventive Dental Care
Preventative care is exactly how it sounds. It’s any service that aims to prevent and diagnose disease and dysfunction. Preventive oral care helps you maintain better dental health and prevent future dental issues. Many dental plans cover at least two preventative visits per year at 100%, while others offer even more.
Coverage for preventative care alone makes dental insurance worth it. Typically, you’ll make up for the cost of the premiums just by showing up for your preventive care appointments. Plus, it could be pretty pricey if you need additional yearly dental care. Dental insurance is a safety net in these situations. Preventative dental services include:
- Routine x-rays
- Oral screenings and checkups
- Cleanings and fluoride treatments
- Sealants
Basic Dental Care
Basic dental care consists of treating damage that has already happened. This includes cavities and other gum issues. Insurance can get tricky when it comes to fillings and crowns. They are covered if they fall under the “basic” category. If it takes more extensive work to restore and treat your teeth, that will fall under major dental care. Basic dental services include:
- Simple tooth extractions that are not impacted
- Fillings
- Periodontist treatment
- Root canals
Major Dental Care
Insurance covers dentures, wisdom teeth removal, and other major restorative care. Major dental work requires extensive and complex procedures. It’s typical of insurance policies to pay roughly half of major restorative care.
Major Dental Services Covered 50%
- Implants
- Crowns
- Dentures
- Bridges
- Impacted tooth extractions
- Oral surgery
Braces and Invisalign Coverage
Orthodontics is in its category when it comes to dental insurance. Orthodontic services consist of correcting or readjusting jaw and tooth alignment. Examples include Invisalign, braces, or retainers. Orthodontic services are usually not covered under family or individual dental plans. Group dental plans through work sometimes include orthodontics if an employer elects to make orthodontic coverage available to their employees and family. Sometimes, it only covers Children under the age of 19.
Cosmetic Procedures
Cosmetic dental services, such as veneers, teeth whitening, bonding, or anything purely aesthetic, are usually not covered under insurance.
Things to Consider When Choosing an Insurance Plan
The first thing to figure out is where you can get dental insurance. Does your employer offer dental insurance? If not, you can buy your own plan.
Insurance can be confusing if you’ve never dealt with it before. It helps to know common insurance language and how insurance works. Here are some terms to familiarize yourself with.
Dental Insurance Premiums
Premiums are the monthly payments for your dental benefits. Your monthly premium is typically higher or lower based on your plan’s coverage.
Dental Insurance Deductibles
Deductibles are the money you pay for dental care before your plan kicks in and starts covering costs for basic and major dental care. Preventative care is typically covered without needing to meet your deductible. Dental insurance deductibles are usually pretty low—around $50 for a single person or $150 annually for a family.
Coinsurance
Coinsurance is the percentage you pay for a dental service after meeting your deductible. As we mentioned earlier, many dental insurance plans cover 80% of basic services. So, once you pay your deductible, your insurance will pay 80% of the remaining cost of care. It’s your responsibility to pay the remaining 20% as your coinsurance.
Annual Maximum Benefit
The annual maximum benefit is the total amount an insurance plan will pay for dental services within a set benefit period—typically a calendar year. Your maximum benefits will reset yearly and usually range from $1000 to $2000 for each member. Most patients don’t reach their yearly maximum unless they need extensive dental work.
Questions to Ask When Insurance Shopping
- What type of insurance plan is it?
- How much coverage do I need?
- What will I be paying for dental coverage and care?
- Which dental services does it include and not include?
- What is considered basic dental care?
- What is considered major dental care?
- Does my current Utah dentist accept this insurance?
- What is the policy’s waiting period for dental services?
Dental insurance may seem so complicated that you just want to put it off forever, but the information above should make navigating dental insurance easier and help you understand how it works. Dental care is critical to your overall health, so we’re on board with whatever insurance will get you to see your Weber County dentist.