Having dental coverage can make it easier to get the dental care you need. But, it’s important to understand that most dental benefit plans do not cover all dental procedures. When deciding on your treatment, dental benefits should not be the only thing you consider.
You should know what your dental plan covers and what it doesn’t. This information can help you understand why your dental benefit plan may not pay for all or even a portion of your recommended treatment. Ultimately, your treatment should be determined by you and your dentist – not by your level of dental coverage.
HOW DENTAL BENEFIT PLANS WORK
Dental benefit plans are not designed to cover all dental procedures. Plans usually cover some, but not all, of your dental costs and needs. Many plans involve a contract between your employer and a dental plan provider, but you can also buy individual plans on your own or through the Health Insurance Marketplaces.
YOUR DENTAL COVERAGE IS NOT DETERMINED BY YOUR DENTIST
Your dentist’s primary goal is to help you maintain good dental health, but not every procedure your dentist recommends will be covered. To avoid surprises on your bill, it’s important to understand what and how much your plan will pay. Your employer and the plan provider agree on the amount your plan pays and what procedures are covered. Your dentist is not involved in deciding your level of coverage.
Your dental coverage is not based on what you need or what your dentist recommends. It’s based on how much your employer pays into the plan. Sometimes, you may have a dental care need that is not covered by your plan. Employers generally choose to cover some, but not all, of employees’ dental costs.
DENTAL PLANS SHARE TREATMENT COSTS WITH YOU
There are certain cost-control measures that dental benefit plans use to determine how they share treatment costs with you. Here are some key terms that are used to describe these measures:
A deductible is the amount of money that you must pay before your benefit plan will pay for any service. It can take more than one service or visit to meet your deductible. Most plans don’t require a deductible for preventive services like cleanings and exams or for diagnostic services.
In most cases, after you meet your deductible you will be expected to pay a percentage of the allowed benefit amount of a covered dental service. This is called coinsurance.
- Your plan may pay 80% and you pay the remaining 20% owed to your dentist. If your bill was $100, then your plan pays $80 and you would pay the remaining $20.
This is the maximum dollar amount a dental plan will pay during the year. Your employer decides the maximum levels of payment in its contract with the dental benefit provider. You would pay for anything over that set dollar amount.
- Your dental expenses: $3,500
- Your annual maximum: $2,000
- You owe: $1,500
If the annual maximum of your plan is too low to meet your specific needs, you may want to ask your employer to consider a higher annual maximum. If your plan also covers braces, there is usually a separate lifetime maximum limit