How Does My Dental Insurance Work?

If you have medical insurance, chances are you also added dental insurance with it. While the two policies are similar in nature, the restrictions on how much money can be spent annually on dental care are usually significantly less, requiring some type of alternative insurance to help offset additional costs you may face.

Waiting Periods

In most cases, your dental insurance will require a waiting period for any significant work. This is true for both standard dental insurance and most supplemental plans. The waiting period is the time that must pass before you can make a claim against these procedures. Some standard work, such as a checkup, will have a shorter waiting period, if any waiting period at all.

When it comes to more involved standard work, such as cavities, there may be a 6-12 month waiting period. For elective work, such as bridge, crown, and braces, the waiting period is usually extended even further. For most plans, that type of work will not be covered for 12-24 months.

Deductibles and Co-Pays

The deductible is the amount of money that you must pay before the insurance plan will kick in. For example, if your deductible is $200, the first $200 of your annual dental bills must be paid by you before any claim will be paid by the insurance company. From that point forward, you will be responsible for the co-pay per your insurance up until the coverage amount runs out.

For the co-pay, the policy will have terms such as an 80/20 split. For example, your first bill after you met the waiting period was for $1,200 with a $200 deductible policy. After the deductive is taken off the bill, you would then have $1,000 remaining. Assuming the procedure is covered, the insurance company would then cover $800 of that bill, with you being responsible for the remaining $200. From that point forward, it would be an 80/20 split until you exhaust the annual coverage.

Annual Limitations

Most dental insurance policies have some type of limit on both the money the policy will pay for any one type of procedure as well as an annual limitation for payouts. For instance, the policy may state that for root canal, its max contribution will be $600 and for bridge/crown work the max contribution will be $500. In addition, the policy may only pay out a maximum of $2,000 per calendar year. Any work that exceeds those limits will have to be covered by you.

Supplemental Insurance

Supplemental policies, just like the one offered here at Wellness Dental Plan, offer additional coverage over and above your main dental plan. These policies kick in coverage where your main dental insurance ends. Keep in mind, though, that most of these plans will also have waiting periods and limitations based on the policy chosen.

Dental Insurance Categories

Most dental policies will break out care into three major categories: Preventive, Basic, and Major. As far as standard policies go, preventive care is usually covered 100 percent. An example of this is your bi-annual checkups with your dentist, cleaning, and annual x-rays.

Basic care would be the next level, which would include cavities, extractions, gum disease, and root canals (this is sometimes included in the Major category).

Major care is generally associated with most elective procedures, such as bridge/crown work, dentures, and implants.

Make note, for most policies, cosmetic work, such as tooth whitening, is not covered with a dental plan. These procedures are meant to improve the look of your teeth and are not considered necessary, so they generally must be covered by the patient in full.

If you are interested in purchasing a New Hampshire discount dental plan to supplement your dental coverage, the Wellness Dental Plan is the perfect choice. We offer plans for individuals, families, and small business owners. For more information, click here.