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Dental Insurance FAQs
Andrew Jacobs, General Manager
What affects the cost of dental insurance?
The cost of dental insurance varies depending on the insurance carrier and the specific plan you select or is offered to you by your employer. Every insurance carrier now has a wide variety of plans.
However, the most impactful factors on the annual cost for you are the annual maximum that your plan has and the coverage rates, which dictate how much of the procedure fee your insurance will cover. The two big factors are how large your dental annual maximum is and the coverage rates associated with your plan.
What is the difference between dental and medical insurance?
The biggest point of confusion for patients is the difference between dental insurance and medical insurance. They are very different. The biggest mistake is for people to compare their dental insurance to how well their medical insurance covers them. They're not the same thing at all.
Often, with dental insurance, you'll have to pay at least something for each procedure. With medical insurance, you often only have to pay up to your deductible, and then your insurance kicks in. That's a significant difference.
Also, the maximums are very different. Typically, dental maximums cap out at about $1,500 or $2,000 annually. Once your insurance has paid out $1,500 or maybe $2,000 for the year, they won't pay anything else that year. That is probably the biggest point with dental insurance that people need to keep in mind.
What are my options for a better dental plan?
A common question I get from patients is about getting a better dental plan. We avoid stating specific insurance companies for various reasons. However, a common theme among all great dental insurance plans is a very high maximum. Something I would consider a high maximum is about $2,500 a year, maybe even $3,000 a year. That would be a good maximum.
You also want to look for the coverage rates for any major restorative work, such as a crown or an implant. If they pay around 80%, that is a good insurance plan.
Another thing to keep in mind if you are switching insurance plans is to be aware of any waiting periods. Often, insurance plans have about a six-month waiting period before they pay for any treatment. For a filling, you might have to wait six months. At Seummit Dentistry, if you want a plan that works well for us, any PPO works phenomenally here, as we take all PPOs.
Is it worth it to have dental insurance for just cleanings?
If you are a patient who does not need any major or minor restorative work, such as crowns or fillings, you might wonder if it's still worth carrying an insurance policy if you're only going to be seen for cleanings. The answer is yes, absolutely. If you have a good dental insurance plan, they will often pay for almost all of your dental cleaning costs. Especially here at Sea Summit Dentistry, if you have PPO insurance, there is often little to no cost for your cleanings, exams, and X-rays. That's right, little to no cost at all if you have PPO insurance. It is very worthwhile to have a PPO insurance dental plan if you really just need your cleanings every couple of months.
What should seniors look for in a dental plan?
If you are a senior and you're trying to find a good dental plan that fits your needs, I suggest going online and looking at the different insurance carriers that offer good PPO plans. Often, if you get in contact with an insurance agent, you can talk to them about your specific needs.
For example, if you need denture coverage or need to come in every three months for your dental cleanings, if you bring that up with them, I'm pretty sure they will help you find a good PPO dental policy that will fit all of your specific needs.
How does dual insurance coverage work?
Sometimes at Sea Summit Dentistry, we see patients with dual insurance coverage, meaning they have two active insurance policies, which is beneficial. Often, you will get much more dental coverage than with a single policy. This is called a coordination of benefits.
If you get something done here at Sea Summit Dentistry, we send out the claim to your primary insurance. After we receive the claim back, we then send it to the secondary insurance. If your primary insurance pays something like 80% of a crown or even just a cleaning, your secondary insurance should have no problem covering the remaining 20%. If you have dual PPO insurance, feel free to come by Sea Summit Dentistry because you are very well covered.
Want to learn more? Call Sea Summit Dentistry at (949) 787-3378 or email [email protected]. Our team is happy to answer your questions and help schedule your visit.