Dental Insurance: 4 Things to Know Before You Buy

Buying dental insurance can be a smart investment that ultimately makes it easier to fit important dental care into your budget. That said, it’s essential to make sure that you have a clear idea of what you’re buying; after all, not all insurance plans are exactly the same! When you’re trying to decide which dental insurance carrier is right for you, be sure to keep these 4 key facts in mind.

1. Coverage for Specific Types of Services Can Vary

When it comes to the coverage they provide, many dental insurance plans follow what’s known as the 100-80-50 structure. This means they will pay 100% of the cost of preventive services such as checkups and cleanings, 80% of the cost of basic restorative services such as fillings, and 50% of the cost of major restorative services such as dental crowns.

However, it’s important to note that these percentages can vary depending on what plan you have. As such, before you buy a dental insurance plan, you should double-check the coverage it offers for specific services; that way, you’ll have an accurate idea of what you’ll be responsible for paying out of your own pocket.

2. PPOs and HMOs Have Different Pros and Cons to Consider

Dental insurance plans come in two main categories: PPOs (Preferred Provider Organization) and HMOs (Health Maintenance Organization). PPOs tend to have higher premiums than HMOs, making them the more costly option. However, HMOs will only cover your care if you visit a dentist within their network; with PPOs, you have more flexibility in choosing a dental provider.

3. There May Be a Waiting Period

Some dental insurance plans come with a waiting period, meaning they won’t provide coverage for certain treatments until a certain amount of time has passed. For example, some plans will only pay for basic restorative services after three months.

Not all dental insurance plans come with the exact same waiting periods, and some plans may not have waiting periods at all. It’s essential to be fully aware of any waiting periods so that you know exactly how long it will be before you can take advantage of the dental insurance benefits you’ve paid for.

4. There Will Likely Be an Annual Maximum

Many dental plans have an annual maximum, which is the absolute most that your insurance company is willing to pay for your dental care within a set 12-month period. If you haven’t met or exceeded your annual maximum before the 12 months are up, the remaining money isn’t carried over; it is instead lost once your plan resets. It’s important to know what your plan’s annual maximum is so that you can come as close as possible to meeting it, thereby getting the most out of your benefits. 

Dental insurance is an invaluable tool that can help you get the care your smile needs without breaking the bank. Making sure you’re as informed as possible before making any buying decisions can go a long way toward ensuring that you choose the dental insurance plan that’s right for you and your budget.

About the Author

Dr. Bianca Sanchez is a graduate of the University of Texas Health Science Center School of Dentistry at Houston. She holds membership with the American Dental Association and the Texas Dental Association. She wants to make the services she offers as affordable as possible for her patients, which is why her practice in San Antonio is in-network with a wide variety of PPO dental insurance providers. If you’re ready to visit a dentist who offers first-class care, you can schedule an appointment with Dr. Sanchez by visiting her website, using her online booking tool, or calling (210) 690-2727.