One of the most important things you and your family can do to keep your teeth and gums healthy is to have regularly scheduled dental appointments. The way most people maintain regular dental care is through their dental insurance. When it comes to paying for your family's care, insurance can be confusing to understand.
It's almost as if dental insurance plans are written in a different language sometimes. What's the difference between a deductible and copay, for example? We recognize this challenge for many, so we put together this simple guide for patients that explains some of the most common dental insurance terminology. Understand your plan better!
Insurance premiums
A premium is the amount of money you pay to your insurer for your dental insurance plan. Premiums can be paid in different intervals—monthly, every few months, or once a year, for example. You can think of your premium like it's almost a membership fee—you pay it to keep your coverage active.
Deductible
A deductible is the amount you pay out of pocket before your insurance kicks in and starts paying for costs. If your deductible is $50, for example, you will have to pay that much first before your insurance helps cover the rest.
Copayment
A copayment, or copay, is a set amount you pay for a dental visit or procedure. For example, you may have to pay $20 every time you visit the dentist for a cleaning. You pay $20 at the end of your visit and your insurance will pay the rest.
Coinsurance
Coinsurance is the percentage of the cost you have to pay after you've met your deductible. If your plan covers 80% of a procedure, you will have to pay the remaining 20%.
Annual maximum
The annual maximum outlined outlined in your plan is the most money your insurance will pay for your dental care in a single year. If your annual maximum is $1,500, your insurance will cover costs up to that amount. After that, you need to pay for any extra costs yourself.
Provider network
A provider network is a group of dentists who have agreed to work with your insurance company. Seeing an "in-network" dentist makes your care cost less. If you see an "out-of-network" dentist, you'll likely have to pay more because they don't have an agreement with your insurance.
Preventive care
Preventive care is one of the most important aspects of your dental care. Preventive care includes important "maintenance" services like cleanings, exams, and digital x-rays. Many insurance plans cover 100% of preventive care because it helps keep your teeth healthy and prevents bigger problems.
Basic services
Basic services include fillings, simple tooth extractions, and gum treatments. Insurance usually covers a percentage of these costs, often around 70% to 80%.
Major services
Major services include crowns, bridges, dentures, and root canals. Insurance usually covers a smaller percentage, often around 50%, meaning you have to pay more out of pocket.
Waiting period
A waiting period is the time you must wait before your insurance will cover certain procedures. Some plans require a six-month or one-year waiting period before they help pay for major services.
Thanks for reading!
Translating these dental insurance terms and knowing what they mean can help you make better decisions about your dental care. You also don't have to go at it alone. If you have questions about your dental plan, it typically has a customer service line to help. The office staff at your dental practice may also be able to shed light on your benefits.
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