At 1st Family Dental, we believe surprises can be fun and exciting, but not when it comes to your dental insurance. We believe all of our patients have a right to understand the fundamentals of how to choose a dental insurance plan.
In Part 1 of our series, we reviewed the basics about some of the different types of insurance available on the market. In Part 2, we have curated a list of questions for you to ask yourself when preparing to shop for coverage, as well as some critical questions to ask your insurance carrier to better understand the benefits available to you in your policy.
Our Guide: How to Choose a Dental Insurance Plan
Get familiar with your dental health needs and goals
Insurance carriers often offer a variety of policies with different coverage levels. It is important to select a plan with features that reflect your needs. Here are some questions to ask as you plan:
Who will be covered by this policy? Policies usually offer individual, individual plus partner/spouse, and family
Are there any special dental needs for those covered by the policy? For example, do you anticipate that you or others may need braces or orthodontic treatment in the near future
Do you or others have existing dental restorations such as crowns, bridges, or dentures? Restorations need regular maintenance and periodic replacement, including restorations over dental implants.
Do you or others have existing treatment plans and know or expect you may need treatment in the near future? Are you experiencing any pain or dental issues right now?
Do you or others have an existing or previous diagnosis of periodontal (gum) disease?
Do you or others have health issues or take medications that may put you at greater risk of developing gum disease or other oral health issues?
Review Your Options: What to Ask the Insurance Carrier
Put yourself in a position of power by asking the right questions to be able to compare different policy options. Here is a list that can help you select a plan that most closely matches the needs you have identified for your dental health.
Is the policy on a calendar year or annual? Does the benefit period begin on January 1 and end December 31 (calendar), or does it begin during another point during the year (annual)? This is important because it will help you and your dental provider keep track of your benefits and ensure you get the most out of them.
Do benefits end with the policy term, or do they accumulate/roll over? Most dental plans have a use-it-or-lose-it policy with benefits, but some policies may allow you to roll over benefits into the next policy term.
What is my annual maximum benefit allowance, and are there deductibles or co-pays required? Most plans limit dental benefit coverage to a maximum for each policy term, which can impact potential out of pocket expenses. Some policies also have deductibles which must be met before insurance benefits are applied or co-pays for office visits. If you have a partner or spouse on your plan, or a family plan, you should also check if those maximums and deductibles are shared between the people on the plan.
What preventive benefits will I receive? Regular visits for check up and cleanings are absolutely essential to a healthy smile for life. Regular cleanings can help prevent the need for other, more costly and extensive treatments down the road. Find out how many cleanings are covered for each policy period for each member on the policy, as well as x-rays and regular checkups. If your plan has a deductible, you should check to see if the deductible applies to regular preventive services.
What are the coverage rates for regular (often known as basic) treatments such as fillings and extractions, and specialty (often known as major) treatment such as root canals and surgical extractions? Many insurance policies divide treatment into “Preventative”, “Basic”, and “Major”, and then define coverage percentages for each category. Your insurance carrier will be able to tell you which procedures fall into each category.
Are periodontal (gum health) treatment benefits included in my plan? Gum disease affects approximately 50% of adults in the United States. If you have had gum disease in the past, or may be at risk, periodontal treatment such as scaling and root planing, as well as regular periodontal maintenance treatments are important to your dental and whole body health.
Are adult and/or child orthodontic benefits included in my plan? If you or a family member may need orthodontic treatment, orthodontic coverage can be an excellent option to include in a dental insurance plan.
Are dental implants included in my plan? Dental implants are now known as the best possible option for replacing missing teeth. If you or someone on your plan are interested in dental implants, you may be interested in obtaining a policy with this option.
Is there a waiting period for any dental procedures? Some insurance policies and carriers set waiting periods on certain types of procedures before they are covered under the plan. If you have an existing treatment plan or dental care issues you know you need to attend to, this waiting period may have an impact on your treatment planning.
What are the replacement periods on dental restorations such as crowns, bridges, partial, and full dentures? Insurance carriers often regulate how often they will replace dental restorations. If you have existing dental restorations or are planning to have treatment done, knowing when your plan benefits will cover replacement will be important to your future oral health.
Congratulations! You have armed yourself with knowledge and information that will help you to choose an insurance policy that works best for you. In the next part of our series on dental insurance, we will be helping you to get the best possible value from your insurance by knowing what questions to ask your dental care provider.
As always, we welcome questions and comments. Please leave a comment below or send us an email at email@example.com.