Understanding Dental Insurance

A cropped view of a man filling out a dental insurance form.

Dental insurance can make your bi-annual trip to the dentist a breeze, but if you don’t properly understand insurance jargon, it can be a nightmare.  To make it easy, we’ve broken down the different aspects of dental insurance.

Co-Insurance, Co-Pays, and Deductibles

We’ve all heard some of these words, but it can be easy to confuse what each of these mean.  Let’s start with Deductibles. A deductible is the bare minimum amount of money that needs to be paid by the patient before the insurance policy will contribute anything. After the deductible is met, your insurance will then cover a percentage of the remaining cost (Co-Insurance). This number will vary, depending on your insurance, but the most common amounts seen are 50/50 and 80/20.

Many plans have a Co-Pay, which must be paid on top of the Deductible. These are often fixed dollar amounts.  

Waiting Periods

Many dental insurance policies have waiting periods in place.  These waiting periods are typically 6-12 months long, and signify how long the insured must wait before having work done.  These are typically in place to prevent people from purchasing insurance with the intent to quickly use it, and then cancel coverage.

Paying for Procedures

For insurance purposes, dental procedures are typically grouped into three different categories: preventive, basic, and major.  To promote healthy practices, it is common for plans to cover a all, or most of the preventive care, some of the basic care, and a smaller portion of the major dental care.  Typically, preventive care includes regular cleanings, x-rays, and sealants.

Basic care, including extractions, gum disease treatment, fillings, and root canals, are often covered at around 80%.  Major care, including bridges, crowns, and dentures are typically covered with a higher co-payment. However, each policy is vastly different and will have different definitions for each category of payment.

You’ll notice we did not mention cosmetic procedures in any of the above categories.  This is because cosmetic procedures such as teeth whitening and shaping are not often covered procedures.  We recommend checking with your insurance provider to find out exactly what is covered with your dental insurance.

Annual Maximum

Your annual maximum is the most your insurance will pay each year for procedures.  Once this amount is reached, you must pay for 100% of the remaining amounts. While some insurance policies will allow you to rollover unused amounts for your following year’s maximum, we recommend you contact your insurance provider to learn whether yours qualifies for an annual rollover.