Dental Insurance–A Basic Guide

We deal with dental insurance all the time so we understand the lingo. If you are interested in learning more, below is a quick explanation of how dental insurance works.

 

What is a maximum?

Your maximum is the most amount of money your dental insurance will pay toward your dental benefits in one year. After you reach your maximum, any remaining costs will be out-of-pocket. Most plan maximums are in the $1,000 – $1,500 range.

 

If I don’t use all of my maximum in one year, does it roll over to the next?

No—typically it is a use-it-or-lose-it policy and you cannot carry forward any unused benefits to the next year. Exceptions do occur but are very rare. This is why it is important to utilize your benefits each year before they run out.

 

What is a deductible?

Your annual deductible is an amount of money you must pay first before your dental benefits will pay anything toward your treatment. Most deductibles are in the $50 – $100 range. On most plans, the deductible is waived for diagnostic and preventative services (i.e. x-rays and cleanings).

 

What do the categories and percentages mean?

Your plan will determine which services fall under which category. Typically:

  • Diagnostic/Preventative—x-rays, cleanings, exams, and fluoride
  • Restorative—fillings, perio (gum) therapy, root canals, and simple extractions
  • Major—crowns, bridges, dentures, and implants

The percentages are the amount that your dental insurance will pay toward those services. Typically we see dental plans paying 100% for diagnostic/preventative, 80% for restorative and 50% for major services up to your maximum amount.

 

Do my regular cleanings/check-ups come out of my annual maximum?

Yes, most policies will pay 100% for your regular cleaning and exam however the cost will be deducted from your annual maximum benefits.

 

How are the fees determined?

As a participating PPO provider, our fees are contracted with your insurance company.

 

What is an EOB?

An EOB stands for your Explanation of Benefits. This is provided by your dental insurance company and should give a breakdown of the services that were performed, any amount they paid toward the services and the portion that is your responsibility.

 

What are waiting periods?

Waiting periods are the amount of time you have to wait before your dental insurance will provide coverage for that service.

 

Still have questions? Give us a call at 303-779-2797 and we are happy to help.