Dental Insurance – What You Need to Know

Dental insurance is available through employers, the public health insurance Marketplace, Medicaid, Medicare Advantage plans and directly from a dental-insurance company. Many dental-insurance policies offer low – or even $0 – out-of-pocket costs for cleanings and other preventive services. Others offer coverage for basic and major procedures. 韓国ホワイトニング

When comparing dental-insurance prices, look for the monthly premium, annual limits and coinsurance rates. Also, check whether the policy has a waiting period and if the dentists you want to see are in the insurer’s network.

Preventive care

As with health insurance, dental insurance plans vary widely in terms of covered procedures. They often categorize procedures using American Dental Association (ADA) 3-4 digit codes. For example, preventive procedures may include exams and cleanings while restorative treatments may involve fillings or other forms of dental surgery. Some insurers encourage preventive care by covering these services 100% while others require a patient to meet a deductible before coverage begins.

Most dental plans have a deductible that the patient must pay before the insurance company will start paying. Some also have an annual maximum that limits how much the insurance company will pay for a procedure. This limit may be based on a calendar year, a company fiscal year or a date of enrollment. It’s important to understand these limits before deciding on a plan.

Restorative care

The restorative care portion of dental insurance helps pay for fillings, crowns, and other more significant procedures. The type of restorative care offered by your plan depends on the specifics of your policy. Most plans provide a list of dentists who have agreed to work at a discounted rate for the insurance company. Typically, this is called a preferred provider organization (PPO).

PPOs typically reimburse patients up to an “usual and customary” fee limit. This is determined by the insurer and may or may not accurately reflect what area dentists charge. PPOs also usually have a deductible and copays.

Another option is a dental health maintenance organization (DHMO). These plans are similar to health insurance HMOs and provide a network of dentists who contract with the DHMO. They are often lower priced than PPO plans and usually don’t have deductibles or copays. Most DHMOs require that you go to the assigned dentist for services and will not reimburse you if you see an out-of-network dentist.

Emergency care

A dental emergency is a scary and expensive proposition, especially without insurance. However, if employees are well prepared, they can get the care they need in an affordable way.

Whether it’s a bad toothache, an injury in which a tooth or teeth have been lost or broken, or severe bleeding from a mouth wound, some problems need to be addressed immediately and should not be ignored. Others don’t require urgent care, but are important to discuss with a dentist during normal office hours.

Most dental plans include provisions for emergency care, but it’s important to know that you may still owe a deductible, co-pay or large percentage of the cost. Also, many dental plans don’t cover pre-existing conditions unless you have been in treatment for a certain amount of time before enrolling in the plan. This is why it’s important to review your plan coverage often.


Most dental insurance plans have a deductible that the patient must pay before the plan begins paying for treatment. In addition, most dental plans have annual maximums that are the highest amount that the insurance company will pay for care in a calendar year. This cap excludes standard preventive treatments and diagnostic services.

Many plans also have a co-payment, which is the portion of a procedure that the patient is required to pay after meeting the deductible. These patient co-payments vary by type of treatment and can be found in the plan summary.

Indemnity plans allow patients to choose any dentist, but they generally reimburse only 50 to 80% of what the insurance plan considers reasonable and customary fees for treatment. Indemnity plans tend to be more expensive than PPO and DHMO dental insurance plans. On the other hand, a DPPO with a large network can provide lower in-network costs than an indemnity plan.


Deductibles are a common component of dental plans, but they can vary significantly from one plan to the next. Some plans have no deductible at all, while others may require up to $1,000 per person before the insurance coverage kicks in. There are also maximum expense limits, which determine how much the plan will pay over a period of time, typically a calendar year. Some dental plans have lifetime maximums, while others may specify an annual limit for each person on the plan.

Different dental plans have different coverage options, so it is important to understand the terms of each before selecting a plan. For example, a PPO allows you to visit any dentist that accepts the plan’s network, while a DHMO usually has a smaller network and requires that you choose in-network providers for most services. Both types of plans may have a deductible and maximum expenses, but they generally offer different coverage for preventive, basic, and major care.


Co-insurance is the way you and your dental plan share costs, after you have met your deductible. It is generally shown as a percentage (for example, 80%/20%) in the plan details.

Your plan may limit the number of visits or amount of coverage for major procedures each year. It is important to know what services are covered and what is excluded from your plan. Dental services are usually divided into categories based on American Dental Association (ADA) 3-4 digit codes. These categories range from preventive/diagnostic to basic, to major.

There are many options for individual or family dental insurance coverage including indemnity plans, Preferred Provider Network (PPO), and Dental Health Managed Organizations (DHMO). Most plans have a network of participating dentists that you can use to lower your out-of-pocket costs. DHMO networks tend to be smaller than PPO networks, but have the advantage of no deductible and less paperwork.