October 5, 2021
Do you know what your dental insurance plan covers? If not, don’t worry – you’re not alone. Medical insurance and dental insurance are two entirely different things, which is why it’s easy for people to get confused about the differences. Because dental benefits and coverage can vary from person to person, it’s crucial to review the details of your specific plan to understand how it works. With that in mind, read on as a dentist in Falls Church shares a general idea of the average dental insurance coverage.
What Does Dental Insurance Usually Cover?
Although every dental insurance plan is unique, most tend to follow a 100-80-50 structure for coverage. Here’s a breakdown of what that looks like:
- 100% – Since preventive dentistry is essential for overall health, most plans cover it fully. These services include checkups, cleanings, oral cancer screenings, and routine X-rays.
- 80% – Standard treatments like fillings and treatment for gum disease are covered at a slightly lesser percentage than preventive services.
- 50% - More complex procedures (i.e., root canals, bridges, crowns, extractions) usually have the least amount of coverage.
Types of Dental Insurance
There are several different types of dental insurance you can choose from. Let’s take a look at some of the most popular ones.
- Preferred Provider Organizations (PPO) – These plans give you more flexibility when choosing a doctor or hospital. They provide a list of preferred in-network dentists, but you can go out of network as long as you’re okay with paying the extra costs.
- Dental Health Maintenance Organization (DHMO) – With this plan, you’re given a list of in-network providers who have agreed to set dental insurance rates, including copays. Although you won’t have a benefit maximum or deductible, you’re only limited to in-network dentists.
- Dental Discount or Dental Savings Plan – These plans allow members to choose from a select group of participating dentists who charge lower rates for their services. However, none of the care is covered by insurance. You simply pay the entire discounted rate out-of-pocket.
Dental Insurance Terms You Should Know
Everyone knows how confusing dental insurance can be. To help you better understand your coverage and the costs involved, here are some financial terms you should know:
- Premium – Your monthly payment for your dental insurance plan.
- Deductible – The amount you may need to pay before your insurance plan starts paying.
- Copay – What you pay every time you visit your dentist.
- Coinsurance – The percentage of costs you pay after you meet your deductible.
- Annual Maximum – The most your dental insurance plan will pay for coverage in a year.
Hopefully, this guide has helped you better understand what your dental insurance plan covers. Now you can make the most of it and keep your smile happy and healthy!
About the Practice
At Purple Plum Dentistry, we strive to make every dental visit as comfortable, relaxing, and fulfilling as possible. Our team of experienced professionals will do everything possible to give you the outstanding dental care you deserve. If you need help understanding your dental insurance coverage, we’re more than happy to help. Visit our website or call (703) 998-4244 to speak to a member of our team.
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