understanding insurance coverage

What Does My Dental Insurance Cover? Understanding Your Coverage

Whether your dental insurance is offered through your employer or the Health Insurance Marketplace, it’s important to know the ins and outs of what your plan offers in order to avoid unexpected costs. Reading over an insurance policy, however, can be overwhelming if you’re not familiar with the language and terminology. So, we’ve created a brief guide to help you fully understand your dental insurance. This is however, just a guide, and you should always consult with your insurance provider regarding the following subject matter.

Premium

A premium is the amount of money you have to pay, usually per month, in order to receive coverage. It might be tempting to choose a plan with a very low premium, but these plans usually provide lower coverage. If you’re comparing different dental insurance options, don’t automatically go for the cheapest policy. Read the details and choose the best coverage that you can comfortably afford.

Coverage

Everyone has their own specific dental needs, so be sure to consider yours before you commit to a policy. Most plans cover common procedures, like cleanings and exams. But, some policies are designed for those who require additional treatment.

The cost of your monthly premium generally increases with the number of treatments covered. For example, a plan that covers braces or implants will have a higher monthly premium than one that doesn’t. If you have any questions about what’s covered in your dental policy, call your insurer and have them explain your coverage. Don’t be afraid to ask questions relating specifically to the procedures you think you might need.

Provider Access

Many insurance companies dictate which dentists you can visit to receive coverage. This can be disruptive in some situations, such as if you’re switching jobs and your current dentist is not an in-network provider for your new employer’s coverage. There are plans out there that allow you to choose the dentist you visit, so if that’s important to you, ask your insurer about this possibility.

Payment

If a dentist’s services are covered by an insurance company, it means they have a contract with that company that usually includes a set list of fees for different treatments.

It’s best to know the fees and the percentage of the costs covered under the plan before undergoing a procedure, so that you can plan your finances accordingly. If you choose to visit a dentist that is out of network for your insurance plan, you are responsible for paying the dentist’s own fee for the service, usually out of pocket.

Deductible

Your deductible is the amount of money that must be paid out of pocket before the insurance company begins to cover your dental care. An insurance plan with a low premium usually has a higher deductible, and vice versa. If you need extensive dental treatment, it is probably a good idea to choose a plan with a low deductible.Provider Access

Many insurance companies dictate which dentists you can visit to receive coverage. This can be disruptive in some situations, such as if you’re switching jobs and your current dentist is not an in-network provider for your new employer’s coverage. There are plans out there that allow you to choose the dentist you visit, so if that’s important to you, ask your insurer about this possibility.

Maximum

Most insurance plans also have an annual maximum for coverage. This means that if you exceed the plan’s maximum, additional costs come out of pocket. It may also mean that there is a limit on the number of procedures you can receive under a plan’s coverage. If you will need a lot of treatment, be aware of your maximum, and consider choosing a policy with a high annual limit.

Your dental policy is nothing to be afraid of. By discussing these issues with your insurance provider, you can know exactly what you’re covered for and how much you will pay for a given procedure. Looking for an Albuquerque dentist? Contact Davis Gribble Hollowwa today. If you have your insurance information on hand, we will be happy to tell you whether we are within your provider’s network, and how much you can expect to pay for common procedures at our office.

Author Info

Dr. Connor Hollowwa

Dr. Connor Hollowwa is an Albuquerque native. He graduated from the Albuquerque Academy and went on to receive a BA from Rice University. His Doctorate of Dental Surgery is from Creighton University School of Dentistry. Before joining private practice he practiced at the state-of-the-art Isleta Health Center’s Dental Clinic, providing modern dental care for the members of the Pueblo of Isleta. In his free time he enjoys playing the piano, fly-fishing, golfing, and skiing.