How does Dental Insurance work?

Denver Dental Insurance“So doc, this procedure is covered by my dental insurance, right?” The answer to that question is a definite “Well, maybe…”

How does Dental Insurance actually work? The first step happens when your employer consults an insurance provider and they decide which coverage to provide for you as the employee. Every insurance company offers multiple coverage plans based on how much your employer wants to pay. However, this means that select plans may pay more for some procedures like crowns than others.

What You Should Know About Dental Insurance:

  • Dental Insurance is a defined benefit plan, where only a certain percentage of treatment is covered.
  •  Dental insurance benefits differ greatly from traditional medical health insurance benefits and can vary quite a bit from plan to plan.
  • Many plans tell their participants that they will be covered “up to 80% or up to 100%,” but do not clearly specify plan schedule, allowance, or annual maximum or limitations.

With the exception of cleanings and x-rays, patients with insurance are able to get a treatment done at a dental office with just a co-pay. Depending on what the treatment is, the co-pay can vary from $20 to $600 or more. However, once you’ve reached a maximum amount – say $1,500 for example – the dental insurance company will not pay any more and any other work done will be coming directly out of your own pocket.

Dental Insurance is useful to have, but if it’s not getting subsidized by an employer, it generally doesn’t pay off. You’ll pay more out of your pocket in premiums than you’ll get in benefits. Your best bet is to start an HSA, or health savings account. That way you can put money away, tax free, to use for medical and dental care that you or your family may need.