In this article you will learn...
Armed with this information, you’ll find yourself not only a better insurance shopper but a better user of insurance once you enroll.
Dental benefits refer to the services and care covered by an insurance plan and the conditions placed on that coverage. Conditions may include the dentists from which the services may be received, the cost-sharing obligations for the plan member, annual or lifetime limits on how much the plan will pay for a specific procedure, or a waiting period during which the plan member must be continuously enrolled before a specific procedure will be covered by the insurance.
Dental benefits are sometimes categorized into three groups:
Preventive dental benefits are insurance coverage for services that attempt to head off future dental problems. For example, annual cleanings and fluoride treatments are preventive services intended to stop new cavities from arising, or lessen their severity.
Basic dental benefits are insurance coverage for minor treatments that are typically low cost. Such treatments would include traditional fillings and white fillings as well as a tooth extraction.
Major dental benefits are insurance coverage for expensive treatments that require more extensive work on the part of the dentist. Classic representatives of major dental treatments are root canals, crowns, and dental implants.
Benefits are not standardized among dental plans, so reviewing your plan’s benefits is essential to determine:
Properly understanding your plan’s benefits helps you avoid paying out-of-pocket for uncovered services. For example, if you enroll in a new dental plan and receive a crown the next month, it will be uncovered if the plan states it has a six-month waiting period before crowns are covered. It’s one of the reasons why you need to learn how to shop for the best dental plan.
Our agents can:
When shopping for dental coverage, always review the details on benefit coverage because it will help you avoid coverage with an unacceptably long waiting period or out-of-pocket costs higher than you can afford.
Below are some examples of benefits and the conditions that may occur. While there are many other examples, these help demonstrate possible ways a particular benefit may be limited. In your local market, you may find some plans with few benefit limits and others with many.
| Benefit | Example Plan A | Example Plan B | Example Plan C | Example Plan D |
| Root Canal | One per tooth per lifetime. First year of enrollment – 10% of costs covered after deductible. Second year – 50% of costs after deductible. All subsequent years, 60% of costs after deductible. | 50% of cost covered after deductible. | 40% of cost covered after deductible. | 6-month waiting period. 50% of cost covered after deductible. |
| Crown | 12 month waiting period, after which 50% of costs are covered. | Year 1: $815 copayment for porcelain crown fused to predominantly base metal. Year 2: $815 copayment for porcelain crown fused to predominantly base metal. Year 3: $815 copayment for porcelain crown fused to predominantly base metal | 30% of cost covered for crown received in first year of enrollment, 40% in second year, and 50% in all subsequent years | Year 1: $495 copayment for porcelain crown fused metal, $531 copayment for porcelain/ceramic substrate crown. Year 2: $495 copayment for porcelain crown fused metal, $531 copayment for porcelain/ceramic substrate crown. Year 3: $495 copayment for porcelain crown fused metal, $531 copayment for porcelain/ceramic substrate crown |
| Dental Implants | 20% of costs covered after deductible in the first year of enrollment, 30% in the second year, 50% in the 3rd year. | $1,500 for surgical placement of implant body. | Dental implants have a $2,500 maximum benefit each year of coverage | 10% of costs covered in 1st year of enrollment, 50% in second year, and 60% in the 3rd year. $3,000 calendar year maximum benefit on implant care. One per tooth in 10 calendar years. |
| Braces | Not covered | Orthodontic benefits are restricted to eligible dependent children up to 19 years of age. The amount of orthodontic service cost coverage increases across the first three years of enrollment: 1st Year – 10%, 2nd Year – 25%, 3rd Year – 50%. There is a $1200 lifetime maximum per person for this benefit. | Orthodontic services (braces and retentions) are covered for children through the age of 18. There is a $1000 lifetime benefit maximum on orthodontic services. Coinsurance fees are normally 50% of the cost after $150 lifetime deductible is satisfied. No waiting period on coverage. | Orthodontia has a $300 calendar year cap and a $1500 lifetime maximum |
| Maximum Benefit | $2,000 | $1,500 in the first year of enrollment, $2,000 in the second, and $3,000 for all subsequent years | $5,000 | $3,000 |
By knowing the limits on your plan’s benefits, you can avoid surprise bills that happen for uncovered care or care whose expense exceeds the annual or lifetime limits for a service. Remember, an informed consumer is the consumer most likely to save money.
Our knowledgeable customer service team will assist you with any questions you may have prior to enrolling in a dental plan. They can guide you through the process of choosing coverage that matches your needs as well as your budget.
