Dental Insurance 101

Dental insurance, simply stated, is insurance that covers the ability to go and see a dentist. Here we cover the basics on dental insurance and help you understand if it’s right for you.

How Does Dental Insurance Work?

PPO plans have a deductible and a maximum that they will pay either on a schedule or based on a percentage of customary billing. It’s very common to have policies of either $1,000, $2,500 or $5,000 of benefits. All those policies have a limited benefit, so they’ll pay out the maximum benefit per year (in this example either $1,000, $2,500 or $5,000). Unlike health insurance where you can bill millions of dollars in claims, no matter how much insurance you bill for dental insurance it has a cap on what it pays.

What Does Dental Insurance Typically Cover?

Most dental plans are PPOs, albeit there are some HMOs available. In most situations, you will get 100% coverage for preventative care like cleanings and checkups and you get a percentage towards bigger things like cavities, crowns, implants and periodontics.

Orthodontia (braces) are covered only on some policies and you would know very specifically if you have purchased a policy to cover orthodontia. Orthodontia is only covered for folks under the age of 19. If you’re 18 or younger that’s when a policy will pay out for orthodontia. That also has a limited benefit that’s defined, like either $1,000, $2,000 or $2,500 and it is a lifetime maximum, not an annual maximum.

Is Dental Insurance Necessary?

Generally speaking, people that only go to the dentist for basic care are not the appropriate people to purchase a dental policy. If you are a heavy user of dentistry; you get crowns, inlays, you’re prone to multiple cavities, then dental insurance is worth the investment. However, there ARE new plans available and there are several opportunities that offer a good return on investment. Some of these new plans offer 3 cleanings, whitening and cavities all covered at 100%. In any situation, no matter what plan or carrier, it is important to do the math and weigh the risk. 

As a group buyer, if you’re an employer, it’s about creating leverage and offering a package to your employees. Spending $50 per person to create a package that’s worth it for an employee is a good investment for an employer. Even if the employee is not seeing thousands of dollars of benefits from the policy, that return on investment for an employer to buy a policy for their employee to create a comprehensive package is very appealing, particularly in this hyper-competitive employee market.

If you need help evaluating your options when it comes to dental insurance, please reach out, we are happy to help!