Many people often assume that dental insurance will cover any treatment they need because they have coverage through their employer. However, that is not always the case. In reality, dental insurance often works differently than medical insurance. Research shows that people without dental insurance are less likely to seek preventive care, increasing their chances of needing expensive treatments like extractions, dentures, or emergency room visits. Even those with insurance may find that dental treatments can be costly, especially for more advanced care like crowns or implants.
Key Things to Know About Your Dental Insurance:
1. Dental Insurance Differs from Other Medical Benefits
We often think of “insurance” as protection against unexpected expenses. However, dental insurance often functions more like a “discount coupon” for various dental care costs. It’s important to understand what your plan covers (routine care, orthodontics, cosmetic enhancements, etc.) and at what percentage (e.g., 70% or 80%) of the usual and customary fees. Keep in mind that the “usual fee” your plan refers to may be higher than expected, and any annual deductible is the amount you must pay before the policy contributes. Also, there is always a cap on the maximum benefit you can receive in a given year.
2. Braces Are Often Not Covered
Dental plans you purchase on your own in the private market usually don’t include orthodontics. However, most employer-based policies offer a lifetime payout of around $1,500 toward the cost of braces. The Affordable Care Act requires plans to provide dental insurance for children up to age 19, but children’s braces are often covered separately only in cases that meet specific criteria.
3. Dental Insurance Has Limitations
Some people believe dental insurance will cover the entire cost of their dental treatment, but this is not always true. Most treatments, including fillings, crowns, bridges, root canals, dentures, extractions, oral surgery, and gum therapy, typically require out-of-pocket expenses in addition to what the dental insurance covers.
4. Know Your Deductible
Many insurance plans have a yearly deductible—the amount you must pay before your insurance starts covering treatments. In most cases, this applies to all treatments except for preventive care like check-ups and cleanings, but plans vary, so it’s important to check with your insurance carrier.
5. Be Your Own Advocate
It is your responsibility to understand the details of your dental plan. You can get help from your dentist or by going online to check your dental coverage details, which should provide a list of participating dentists and your group number. Many dental offices can help you with questions about your insurance, but remember that a busy office may not know all the specifics about every patient’s coverage.
6. You Can Get a Pre-Treatment Estimate
If you want to know exactly how much you will need to pay for your dental treatment, you can ask your dental office to submit a pre-treatment estimate (also known as a pre-authorization or pre-determination). Once you receive the estimate, you can schedule your dental treatment based on your needs and budget.
7. Not All Dentists Accept Dental Insurance
Some dentists accept few or no dental insurance plans. This means your out-of-pocket expenses may be higher with one dentist compared to another who participates in your insurance plan. Even if your dentist does not participate with your insurance, you may still be able to use it for partial payment. Ask the office staff for more details.
Contact Ottawa Dental Service to connect with a caring team of dentists covered by many dental insurance plans. The team is committed to providing a positive experience for your children’s first dental visits, creating a comfortable and welcoming environment for you and your family.