The dental insurance team can be a bit confusing, especially with all the complex terms. In modern times, people lead such busy lives that they do not have enough time on their hands to do their individual research on such topics. Therefore, it is important to get an overview of how dental insurance policies function in order to effectively choose the appropriate dental care.
A dentist near you can assist you in understanding the insurance plan by explaining what will be covered for you so you have confidence in the treatment and its cost.
How Dental Insurance Works?
Dental insurance is a plan that helps pay for dental care. You pay a monthly fee or premium, and the insurance company has coverage for part or full of your dental cost depending on your specific plan. But there are some terms and rules you need to know to make sense of how it works.
Common Dental Insurance Terms Explained
1. Premium
This is the amount you pay every month for your dental insurance. Think of it like a membership fee that allows you to access dental care. If you don’t pay your premium, your insurance may not cover your dental cost.
2. Deductible
A deductible is the amount of money you have to pay yourself before your insurance will pay for your dental care. For example, if you have a deductible of $50, you will have to pay the first $50 of your dental bills. After that, your insurance will cover the rest.
3. Co-payment (Co-pay)
A co-payment is the amount you pay each time you visit the dentist. For example, let’s say your insurance covers most of the cost of a check-up, but you still have to pay $20. That is your co-payment.
4. Covered Services
These are the treatments and procedures that your insurance will pay for, such as cleanings, fillings, check-ups and more. Be sure to check what services are covered by your dental plans so you don’t end up with unexpected out-of-pocket costs.
5. Network
A network is a group of dentists who work with your insurance company. If you visit a dentist within the network, your insurance will cover more of the cost. If you go to a dentist outside of the network, you’ll likely have to pay more.
6. Maximum Benefit
This is the maximum amount of dental care expenses that your insurance will cover in a year. After this limit, you will have to pay for any other services yourself. It is important to keep track of your maximum benefit to avoid surprises.
7. Pre-authorization
Pre-authorization is the process where your dentist checks with your insurance company to see if a certain treatment is approved. For example, if you need a crown, your dentist may need pre-authorization to make sure the procedure will be covered.
Traditional Dental Insurance
The most common type of dental insurance is traditional dental insurance. These plans usually have a list of benefits for certain dental treatments. For example, they may cover preventive care like cleanings, exams, and more but they may not cover cosmetic procedures like teeth whitening.
Traditional plans often have limits on how much the insurance will cover in a year, and you may need to pay a portion of the cost, generally through a co-payment, for services like preventive care. This helps prevent larger dental problems down the line.
Tips for Understanding Your Plan
1. Check Your Plan’s Coverage: Every plan is different, so make sure you know exactly what is covered and what isn’t.
2. Pre-authorization: If you need a major procedure, ask your dentist if they need to get pre-authorization from your insurance company. This ensures that the procedure is covered.
3. Stay Within Your Network: To save money, make sure your dentist is part of your insurance company’s network.
4. Watch Your Maximum Benefit: Know how much your plan covers each year to avoid unexpected costs.
Understanding your dental insurance can help you make the right decisions for your care and avoid surprises at the dentist’s clinic. Don’t hesitate to reach out to your dentist or insurance company if you have questions about your plan.
Call Dentus Family Dental to Schedule Your Appointment!
At Dentus Family Dental, we’re dedicated to providing high-quality dental care for patients of all ages. Our friendly team of dentist in St. Albert offers a range of services, from regular check-ups to more advanced treatments. We believe in helping you maintain a healthy smile for life.
Visit us today and take the first step towards better oral health!