• Robert Routt

How does dental insurance work? What do I pay for?

Updated: Jan 30

Dental Insurance

Dental insurance plans are similar to health insurance plans...

You pay a monthly amount, which is your premium.

The amount you pay out-of-pocket for services covered by your insurance plan before it begins to pay is your deductible.

Coinsurance is a percentage of your covered expenses after you reach your deductible. In most cases, coinsurance is either 20% or 30%.

Under some dental plans, you might pay a fixed cost for certain services, like X-rays—this is called a copay.

How much will dental plans cover? Are there limits to what they’ll pay?

Yes. Most dental insurance plans have a maximum benefit for the year. For most plans there is an annual maximum from $1,000 to $3,000 depending on your plan.

Does the Affordable Care Act (ACA) cover dental?

No, the ACA, also known as Obamacare, does not cover dental coverage for adults. You will not face a tax penalty for not having dental insurance. However, the Affordable Care Act does mandate that dental insurance be made available to you if you have children, though you aren’t required to buy coverage for yourself as an adult.

Can I buy dental insurance without having health insurance?

Yes. It is standalone coverage. You do not need a major medical plan to purchase a dental plan.

What do most dental insurance plans cover?

Dental plans include coverage for preventive care like routine exams, cleanings, and X-rays. Some plans require a copay for preventive services while others cover those services 100% with no copay. It depends on the plan you choose, but preventive services are usually covered. Many dental plans also include coverage for basic services like fillings and extractions, and major services like root canals, crowns and more.

Is there a waiting period for dental insurance once I’m covered?

It depends. There is no waiting period on preventive services once you become covered, meaning as soon as you purchase the dental insurance you would be able to use the preventive care benefits. While some plans have no waiting periods, on other plans basic and major services may have waiting periods ranging from 4 to 12 months.

What is the difference between in-network and out-of-network care?

Cost. In-network dentists agree to accept a lower negotiated rate on services, meaning you pay less before your insurance carrier even gets involved. Non-network dentists can bill a patient for any remaining amount up to the billed charge.

Finally, when you stay in-network, you usually do not have to submit claims yourself. The dental office will handle the paperwork, saving you the cost of your time.

It’s a good idea to check on the number of dentists near you who are in-network before you buy a dental plan. If you already have a dentist, be sure to confirm if he or she is in-network. By choosing an in-network provider, you are making dental care more affordable for yourself.

Are there special plans or dental insurance for seniors?

Many dental plans have no age limit for coverage, so customers of any age can enroll in coverage. However, there are plans available specifically geared towards customers around Medicare age that may offer more age-relevant benefits. In many states, plans are available for customers age 64 and older that include coverage for hearing aids and exams.

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