Many people shopping around for coverage wonder whether dental insurance is worth the monthly premium costs.
Dental coverage works more like a prepayment plan than insurance, protecting your finances from unforeseen catastrophic events. An annual maximum benefit caps claims at deficient levels.
However, all is not lost because most PPO plans have a hidden benefit: the steeply discounted allowed amount negotiated by the insurance company with thousands of members (potential patients).
Articles on this Topic
Medicaid provides free dental insurance to low-income children throughout the country and often (not always) extends these benefits to adults over 21, disabled individuals, pregnant women, and seniors dual-eligible with Medicare.
However, the coverage is not uniform, as each state decides whether to support benefits for dental work and which services to include or exclude.
Seniors and adults with disabilities rely on Medicare to address their health needs. However, the government benefit does not cover dental work by design.
Meanwhile, oral surgeons perform medical and dental procedures billing both types of insurance, so it is natural to ask which operations Medicare Part B or Advantage plans might cover.
Learn how a letter of medical necessity is critical to getting the benefits you need.
People with dental insurance often learn the hard way that their plan will deny many claims because the contract contains a long list of exclusions, and sometimes procedures are deemed unnecessary.
The correct course of action after your dental plan denies your claim depends on the reason. Most times, your options are limited because your premiums fund preventive rather than restorative care.
Dental insurance is a misleading term because these plans promote preventive services to help patients maintain good oral health. However, their value quickly fades when you need expensive treatment.
The maximum annual benefit means that patients will have to pay most expenses out-of-pocket because the average limit of $1,500 does not stretch very far. Find ways to cope once you reach to cap.
Patients without dental insurance do not have to self-pay for every treatment for their mouth, teeth, and gums.
Sometimes, your healthcare plan can step in and save the day. Medically necessary procedures fall under the medical umbrella and qualify for coverage – with no annual benefit maximums.
In a utopian society, people could buy dental insurance with no waiting period for major work. They buy the coverage on the way to the dentist, have the work done, and drop the policy right after the claim was paid.
Would you take that deal if you were the insurance company? We do not live in a utopian society. Supplemental dental insurance comes with waiting periods, and works for those who plan.
We all may be familiar with how traditional dental insurance plans work. You visit the dentist, had your dental card to the billing manage, the office submits the claim, the insurance company pays the office, and then you receive a bill for the uncovered balance.
Sometimes those uncovered amounts are quite large, which is why you might need a supplemental policy.
Most dental insurance plans will cover medically necessary procedures, the treatments that affect your teeth, and your gums’ long-term health and viability.
However, all bets are off when it comes to services that improve appearance only. You may have to purchase an optional rider or find a cross-over point.
Learn the secrets to success.
Not all dental insurance plans work the same way. PPO and EPO designs include a contracted amount that the provider agrees to accept as full payment for covered services.
If your provider charges more than what your plan approves or allows you could have reason to dispute the bill, or you may have to bite the bullet. Your fate depends on several factors.
Paying for oral and maxillofacial surgery without dental insurance might get very expensive if you have to self-pay 100% of the procedure.
Health insurance will sometimes step in to save the day when an operative procedure is medically necessary: the service treats an illness or injury to your mouth, jaw, or face.