Behind every great smile is a dental plan that helps to improve the oral health of the people it covers. But before you choose your dental insurance, it’s important to understand the way a plan is structured, what it covers, and the value it provides for the cost. Whether you’re planning for braces, or just want to stay on track with cleanings, knowing how dental insurance works will help you choose the right plan for your family’s needs and budget.
There’s much to consider before deciding on a dental plan, but your dental insurance should do these two things:
- Provide comprehensive dental benefits, especially preventive care
- Provide access to a dental network
Preventive care can keep you and your family healthy and may lessen the need for more costly dental procedures down the road. Utilizing dentists within the network will provide savings dental care for you and the whole family.
Dental plans are available to you in two ways: through your employer or directly from a company that offers dental insurance.
Each dental plan can contain a combination of qualities. When weighing your options, be sure to compare these characteristics based on what your family needs:
Dental plans may feature different options and incentives (what is meant by incentives?), but the one thing nearly all of them emphasize is preventive care. Dental insurance is designed to make it easier for you to prevent serious oral health conditions like tooth decay.
Your dental insurance should allow you at least one preventive cleaning per year. In addition to cleanings, consider whether the plan offers:
- Routine oral exam
- Fluoride treatments
Different plan types will offer varying network sizes. It’s important to determine:
- The number of dentists in the network
- If the network includes dentists near your location and/or a dentist you prefer
- Whether you must choose a primary care dentist or have one assigned to you
- Which services are considered “in-network”
- If certain out-of-network services are still covered in some way
Dental plans are usually set up to discourage people from using them only for emergencies or major procedures. That’s why most plans will place waiting periods on certain service types. Generally, you might have to wait up to six months or less for cavity fillings and other minor dental procedures, and up to 12 months or less for major dental work, such as crowns.
Here are some of the out-of-pocket costs you may encounter with dental coverage:
- Deductibles. Some dental plans include a deductible that you must meet before dental coverage will kick in. Others, such as dental indemnity plans, will require you to pay up front for services and then submit for partial reimbursement later.
- Copays. Find out if your dental plan requires you to pay a certain amount out of pocket each time you visit the dentist.
- Coinsurance. Some plans will begin to partially cover the cost of services after a deductible has been met. The coinsurance amount will vary based on the dental service performed.
Some dental plans place a cap on the total dollar amount the plan will cover for you in a given year, called an annual maximum. The annual maximum is important to consider, especially if it applies to more than one family member. Some plans will allow you to tap into your annual maximum’s value if you do not spend it all in one year. Some dental plans, for example, will allow you to roll over portions of your annual maximum that you do not use to the next year as long as you complete your preventive screenings. That can come in handy in the event you need major dental work.
Find out which procedures your dental plan will not cover because they are considered cosmetic. For instance, some dental plans consider certain types of crowns cosmetic.
Learn if you can deduct your dental insurance premium from your taxes. Your dental plan premiums may be tax deductible, depending on how they are paid and how you are using your benefits. For example, you may be able to deduct your dental plan premium if you are using your benefits for preventive oral care. Cosmetic procedures, such as teeth whitening, would typically not qualify for a tax deduction.
If you’re paying your dental premium using a Health Savings Account or Flexible Spending Account, you would likely not be eligible for a tax deduction, as the money in these accounts is already pre-taxed.
You may be covered for dental benefits by more than one plan, such as when you and your spouse both have separate dental insurances. Your dental insurances should coordinate benefits so that the dental care your family needs is covered by each insurer.
For example, if the dental plans only offer one cleaning each per year, that doesn’t mean you will be covered for two cleanings. Make sure to check if coordination of benefits is offered by each plan.
If you anticipate the need for major dental work, or just want to get an idea on service pricing, ask your dentist for a pre-treatment estimate. This can help you get an idea of how much money different procedures will cost.