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How Does Dental Insurance Work?
We suggest filling out the form and letting our friendly agents explain it,
But in general:
Dental insurance plans are intended to reduce the cost of dental care. Providers such as Blue Cross typically negotiate lower fees with in-network dentists and also pay ("cover") a percentage of the reduced fee. You pay the rest out of pocket. Here’s how the savings break down:
Preventive: Dental insurance plans typically cover 100% of the cost of preventive care, which includes annual checkups, bitewing x-rays, and routine cleanings. No cost to you.
Basic: Most insurance plans cover 80% of the cost of "basic," uncomplicated services, such as fillings, simple extractions and some types of deep cleanings.
Major: Dental insurance typically covers 50% of treatments such as root canals, crowns, bridges and dentures.
Over the phone, on our website, in person. As always with Health Options Insurance working with an advisor is 100 percent free of charge.
Call us 877-578-0907
Dental insurance knowledge
Health Options Insurance • Tips For Choosing a Dental Plan
These are tips that our insurance advisors have compiled for the do it your self kind of person. For everyone else, just call or fill out the form above and we'll take the worry away.
1. Identify the type of dental care you need.
Here are some questions to ask your self when choosing a dental plan...
WILL I NEED?
only preventive services ( 2 cleanings, one exam + x-rays each year ) ?
basic services including things like fillings or simple extractions?
major services such as root canals, oral surgery, crowns, bridges or dentures?
an ACA qualified dental plan that offers pediatric essential health benefits?
If you are considering purchasing a qualified dental plan (QDP) with essential health benefits (EHB), it is important to consider the following:
Are your Dependents 18 years or younger?
Is dental coverage embedded in your medical plan? If yes, consider: why you may need additional coverage.
Do the adults have coverage?
Does the health plan’s annual deductible have to be met for dental services to be covered?
Are your dental insurance benefits enough to cover all of your likely dental services?
2. Review the types of dental available.
Dental PPO plans are the most popular type of plans today. With a Dental PPO plan, you will have access to a network of providers who have agreed to accept negotiated, discounted rates for their services. With a PPO, there is an annual maximum and a deductible that will need to be met. When you visit an in-network dentist or specialist, most plans cover your preventive services in full; however, depending on the specific plan you select, other services may be covered up to a certain percentage (coinsurance) of the network-negotiated discount rates.
The plan allows you to visit any dentist you choose and still receive coverage for services. If you visit an out-of-network dentist, benefits are paid based on the network-negotiated rate and you will be billed for any remaining amount up to the billed charge.
As an added bonus, all our Dental plans include a Hearing Savings Plan at no additional cost
Fee schedule plans pay for covered services based on a scheduled reimbursement amount per procedure. With a fee schedule plan, there is an annual maximum and a deductible that will need to be met.
The plan allows you to visit any dentist and receive coverage for services. You will be responsible for the cost difference between the dentist's rate and the scheduled amount. Typically you will have the lowest out-of-pocket costs when you use one of the dentists or specialists in our network. As an added bonus, all our dental plans include a Hearing Savings Plan at no additional cost.
Cleaning Only Plans—Cleaning Only plans pay a certain percentage of two annual exams and cleanings. With the Cleaning Only plan, there is an annual maximum, but no waiting periods or deductible. The plan allows you to visit any dentist you choose and still receive coverage for covered services. Typically you will have the lowest out-of-pocket costs when you use one of the dentists or specialist in our network.
3. Compare the dental plan coverage and evaluate the available dental plans based on your needs
Consider the following key areas during your evaluation:
Procedures and services covered. Make sure that the category of service (preventive, basic, major) covers the care that you predict you or your family will need in the future. Consider the out-of-pocket cost for procedures that your family may need that are not covered when you compare it to a plan that covers the procedures.
Costs. Premiums are a portion of the costs associated with dental insurance. If a plan has a deductible, that amount must be paid before your insurance pays any of the incurred fees. Preventive care services are usually available without having to meet a deductible. Preventive care is also a great way to reduce the likelihood of more expensive treatment in the future. Finally, if your expenses exceed the annual maximum, you will be responsible for the remaining amount.
Waiting periods. While there is no waiting period for preventive or basic services on most plans, there is a 12-month waiting period for major services like root canals and oral surgery. We do offer plans with no waiting period in most states for an additional charge.
4. Evaluate the network.
With our dental insurance PPO plans, you have the flexibility to choose any dentist for procedures and services. You can maximize your savings by using one of your in-network providers. Review our Network Providers to locate your current dentist or to choose a new dentist who is in network and offers the dental care you and your family need.