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Affording the dentist is a big problem for many families. Dental insurance may be a great option to ensure that you and your family always have access to the dental treatment you need. With the rising cost of going to the dentist, many people are struggling with the decision of whether or not to purchase dental insurance. Whether you are considering buying dental insurance through your employer or independently, be sure to investigate several different plans and ask questions about the factors listed below.
- 92% of adults 20 to 64 have had dental problems in their permanent teeth
- 26% of adults 20 to 64 have untreated decay
- Only 57% of the total population have dental coverage
- “Lack of insurance” is the most commonly cited reason for not visiting the dentist
Proper dental hygiene equals better health
The cost of not taking care of your oral health could be more. Those without individual dental coverage are less likely to get routine dental care, meaning they seek out a dentist only when they have a problem. By then, more extensive and more expensive measures may be necessary, and major problems linked to poor oral health (like heart disease and diabetes) are more likely to appear. Doing nothing now means you might pay more later. There is multiple plans with different levels of benefits to help you find the best dental insurance fit for your budget.
The yearly maximum is the most money that the dental insurance plan will pay within one full year. The yearly maximum will automatically renew every year. If you have unused benefits, these will not roll over.
Network of dentists
If the plan requires that you see an In-Network Dentist, ask for a list of the dentists in your area with whom they are contracted so you can decide if they have a dentist you would consider seeing. If you wish to stay with your current dentist, some policies allow you to see an out-of-network dentist.
A waiting period is the length of time an insurance company will make you wait after you are covered before they will pay for certain procedures. Many dental plans have done away with these. For instance, if you need a crown and the policy has a 12 month or longer waiting period, chances are you could have already paid for your crown while you have been paying your premiums and waiting.
Missing tooth clause and replacement period
A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. More than 90 percent of dental insurance policies carry a “replacement clause.” A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
According to most dental insurance companies, dental procedures are broken down into three categories:
- Preventative - Most insurance companies consider routine cleanings and examinations as preventative dental care, however, X-rays, sealants, and fluoride can be deemed as preventative or basic, depending upon the specific insurance carrier.
- Basic or Restorative - Basic or restorative dental treatment usually consists of dental fillings and simple extractions. Root canals can be considered basic or major. However, the majority of dental plans list root canals as basic.
- Major - Crowns, bridges, dentures, partials, surgical extractions, and dental implants are dental procedures that most dental insurance companies consider as a major procedure.
Since all dental insurance carriers are different, it is important to clarify which dental procedures fall under each specific category. This is important because some insurance plans don't cover major procedures and others have waiting periods for certain procedures. Let us know if you will need major dental work. We have plans that cover major services day one.
UCR (usual customary and reasonable)
Some dental insurance companies use what is called a Usual, Customary, and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set. If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist or pediatric dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket, however, you cannot put a price tag on quality dental care.
Cosmetic dentistry and dental insurance
Cosmetic dentistry is any type of procedure done for vanity purposes only. Teeth whitening is very popular. While the effects are gorgeous, keep in mind that 99.9 percent of dental insurance companies won’t pay for cosmetic dentistry.