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Every type of insurance is a little different—from homeowners to auto to health. Even health insurance and dental insurance plans have their similarities and differences. Whether you are buying dental insurance for the first time, or the first time in a long time, read through this article to learn more about how your dental plan works, how to use it, and how certain dental plan term meanings may vary in meaning from health plan terms.
Not all dental plans are the same. Some focus heavily on preventive care—and typically have lower premiums as a result. Others have more robust benefits for basic or major care (e.g. fillings, crowns, root canals)—and typically have higher premiums as a result.
Shop around to find coverage that meets your oral health needs, includes your preferred dentist and oral healthcare providers, and that you also consider affordable. You can get a quick quote online or by speaking with a licensed health insurance producer who sells dental policies. Call the number at the top of your screen to learn more about your dental benefits options.
Dental insurance typically provides benefits for three categories of oral care: preventive, basic and major. What your plan pays for services in each category may vary. For instance, many—but not all—dental plans cover preventive care such as cleanings and exams at 100 percent and with no waiting period. Certain services may also be subject to a waiting period before benefits may be used.
Before you receive dental services, read over your plan materials and always call your dental insurance company with questions regarding benefits.
As you would with healthcare, call the dentist’s office and schedule an appointment. Verify that the provider accepts your dental insurance plan—even if their website says they do.
If your dental plan requires you to visit network providers or offers a discount when you utilize providers in a certain network, search the network provider directory to find them. Provider directories are often available online, or you can call the plan’s membership services number.
When you check in for your appointment, you will need to provide your dental insurance card. At that time, you may owe a copayment for services, as outlined in your dental insurance policy. Not all plans and services require copays, which is another reason to become familiar with your dental benefits.
Dental claims are paid much like healthcare claims. When you visit a participating provider, that provider will submit your dental claim. Your dental plan will pay its share, if any, and send you an explanation of benefits (EOB) that details how the claim was processed including the portion paid by the plan and the portion you can expect to pay. An EOB is not a bill. You will receive a bill separately.
When you shop for dental insurance and look over your policy materials, you will notice some of the same terms used in your health insurance policy. While some of these terms mean the same thing for both types of coverage, others may mean something a little different when used for dental insurance. Some examples:
|Term||Dental Insurance Definition||Same or Different?||Health Insurance Definition|
|Premium||The amount you pay to your dental insurance company for coverage. Paid monthly, quarterly or annually.||Same||The amount you pay to your health insurance company for coverage. Paid monthly, quarterly or annually.|
|Deductible||The amount you must pay out of pocket for covered services each year before your dental plan begins to pay its share.||Same||The amount you must pay out of pocket for covered services each year before your health plan begins to pay its share.|
|Copay||The amount you pay up front for dental care—may vary by covered service.||Same||The amount you pay up front for healthcare—may vary by covered service.|
|Coinsurance||The percentage your dental plan pays for covered services. You pay the remainder out of pocket.||Same||The percentage your dental plan pays for covered services. You pay the remainder out of pocket.|
|Annual maximum benefit||The most a dental plan will pay for covered services in a year.||Different||Also known as an annual limit, the Affordable Care Act banned annual maximums from individual major medical plans as of 2014.|
|Waiting period||Certain services may be subject to a waiting period before benefits begin—this applies to individual and employer-based dental plans.||Different||With an employer-based health insurance plan, employees may be subject to a waiting period (often 30 to 60 days) before they can begin benefits.|
If you need further explanation or want to know more about your specific dental or health plan benefits, contact your dental or health insurance company for assistance.
Consult with a licensed health insurance producer to learn about your coverage options and what the best dental insurance plan for you might be. These individuals can also explain more about how dental insurance works and answer your specific questions.
Call the number at the top of the screen to connect with a licensed health insurance producer.
Originally posted July 20, 2016.