Dental Insurance Everything you want to know (but were afraid to ask)
People often are confused about dental insurance, because it is confusing.
We’ve done our best to answer some of the most common questions right here.
Questions & Answers:
Most dental insurance is provided by employers as part of group insurance.
If you don’t have this through an employer, you need to pay for an individual policy, which can costs $400-$500 per year.
If all you need is a 2-3 cleanings a year, it may be more financially advantageous to pay out of pocket for these services.
While you might think that dental insurance becomes more valuable when it comes to bigger procedures, be careful to check the fine print of any plan. There may be waiting periods, and there is always a yearly maximum.
Always check the details and see what each individual plan offers.
Dental insurance is not designed to pay all of your treatment but rather as a partial aid.
Dental insurance really should be called dental assistance. It is an agreement between you and the insurance company.
Most dental plans have a ceiling, meaning there is a maximum amount they will pay out on your policy per year. This usually between $1000 and $2000.
Our staff will work with your insurance coverage to assure that you receive the maximum benefits described by your policy.
An HMO means you have to go a dentist in a small network determined by the insurance company.
A PPO gives you more options, allowing you to see dentists in the same network OR outside the insurance company’s network that accepts the insurance.
Another option is an indemnity plan, which allows you to see any dentist.
Cost is the determining factor. An HMO is typically the cheapest, with the indemnity plan being the most costly.
A deductible is the amount of money you have to pay out of pocket before the insurance company will pay their part of the bill.
The important thing to realize is that your dental insurance is that while your may say they cover 100% of preventative care like cleanings, 80% of basic procedures like fillings, and 50% of big procedures like crowns – these are based on the fee schedule (prices) set by the insurance company, not by the prices of your dentist.
The National Association of Dental Plans breaks it down like this:
Dental benefits overcome consumers’ top concern about getting the care they need—cost. The seven types of procedures are broken into three areas of coverage for payment purposes, i.e. preventive, basic and major.
Most plans cover 100% of preventive care and apply co-payments, either as a dollar amount (DHMOs) or as a percentage (DPPOs and Dental Indemnity/ or Traditional Insurance) to other levels of care. Preventative care usually includes periodic oral evaluations, x-rays and sealants. (NOTE: Sealants may be limited to certain age groups.)
Basic procedures, i.e. office visits, extractions, fillings, root canals, and periodontal treatment for gum disease, are typically covered at a lower percentage amount, for instance 80% (sometimes 60%), or with lower dollar co-payments in the case of a DHMO.
Major procedures, i.e. crowns, bridges, inlays, and dentures are usually covered at the lowest percentage, such as 50% or a higher dollar co-payment in the case of a DHMO. Root canals are also sometimes covered in this category rather than as a Basic procedure, so check your coverage. Some carriers now offer coverage for implants under this category of coverage.
No dental insurance?
No problem. We offer you a great dental plan.
Traditional dental insurance premiums are expensive, and insurance benefits are extremely limited on most plans.
Paying out of pocket can be expensive too.
Fortunately, we have a better option available to you.
Now you can afford dentistry – and you can have the smile you’ve always wanted – with our in-house dental savings plan.
The good news is that as a member of the Del Mar Family Dentistry Savings Plan, all of your preventive care services (including cleanings, x-rays and exams) are 100% covered in our office.
This plan is available to both new and existing patients.
Ask us about the Del Mar Family Dentistry Savings Plan, and how it can help make taking care of your smile affordable for you and your whole family!
- Two dental cleanings
- Two Exams
- One set of x-rays
- Yearly oral cancer screening
- Custom take home teeth whitening trays (includes 2 boxes of bleach)
- Enamel therapy treatment, as needed per visit
- 15% savings on all dental procedures, when paid in full at the time of service
- A 10% savings on Invisalign/ Specialty Services
People love this plan.
“Given that I am now without Dental Insurance, they offer an affordable annual plan that includes two teeth cleanings and x-rays. I have never had an unpleasant experience, and I’ve managed to live 26 years without a single cavity. I think that is enough evidence of their quality of work! Highly recommend.” – Colin F.
“I belong to a program that you should ask about when you call them… for a very reasonable annual payment you receive 2 cleanings, x-rays, a healthy discount on all dental work (yes Crowns), visits with Dr. Trudeau and even free teeth bleaching (trays included). And I love the new office in Solana Beach!” – Kay H.