How Does Dental Insurance Work?

Dental insurance is a lot like your health plan — you pay a monthly premium and visit a dentist in your network. Just like health insurance, dental insurance can reduce your overall expenses and help you catch problems early. It also supports more than a beautiful smile. Dental care protects your general health and reduces the risk of conditions like heart disease.

How It Works

Dental insurance usually covers the total cost of preventive services, like routine exams and cleanings. If your dentist determines you need to get work done, you can expect to pay a deductible and a portion of the procedure.

Each dental insurance plan is different. Before you see a dentist, review your policy and find out how much you’ll have to pay out-of-pocket. It also helps to ask your dentist for an estimate before you get treated so you know what to expect.

The following terms can help you understand your dental insurance plan:

• In-network provider: Your dental insurance plan might have a list of in-network providers. You’ll need to choose a dentist in your plan’s network to receive the most coverage. Otherwise, you’ll pay more out-of-pocket.
• Premium: A premium is the amount you pay each month for your dental insurance plan. In California, the average monthly premium for a standalone plan is around $53, though it might be as low as $15 a month.
• Deductible: The deductible is the amount you pay before your dental insurance pays anything. Some services, like preventive care, might not have a deductible and are fully covered. You may have to pay a deductible for getting a cavity filled or other restorative services.
• Coinsurance: Once you meet your deductible, you’ll have to pay a percentage of what’s left of the service. This is called coinsurance.
• Copay: A copay is the fixed amount your dentist sets that you have to pay to receive treatment. Copays vary depending on the type of service and could be as low as $10 or as high as $50, for instance.

Types of Dental Insurance Plans

Dental insurance is usually available through an employer or health insurance exchange. No worries if you can’t get dental insurance through work — you can buy a plan on your own.

In some cases, dental insurance comes with a health insurance policy. For example, children enrolled in a health plan through Covered California automatically have dental coverage.

You can choose from a few types of dental insurance plans, such as:

• Dental health maintenance organization (DHMO) plan: DHMOs offer comprehensive benefits for a monthly premium. With a DHMO, you must use an in-network dentist to get coverage. Your dentist can refer you to an in-network specialist when needed.
• Dental preferred provider organizations (DPPO) plan: Most commercial policies are DPPOs. This type of plan creates agreements with dentists to offer lower fees. With a DPPO, you can go out of the network, but you’ll pay more out-of-pocket.
• Discount dental plan: A discount dental plan isn’t a type of insurance, but it can help reduce dental expenses. With this option, you’ll get a discount on services offered by a particular group of dentists but will pay out-of-pocket for care.

What’s Covered

Coverage depends on the type of plan you have. Most plans follow a structure that pays 100% of preventive care, 80% of basic procedures and 50% of major procedures.

Preventive Care

Dental health insurance typically covers preventive care in full. This includes services like teeth cleaning, X-rays and routine exams.

Basic Care

Your policy will likely cover a portion of basic care. For example, it might cover 80% of the cost of filling a cavity after you meet your deductible. You’ll need to pay the remainder — but only if you use an in-network provider. Choosing an out-of-network provider, in this example, may mean your plan will only cover 60% of the cost.

Although this can vary depending on your plan, basic care typically includes root canals, fillings and infection management.

Major Procedures

Major procedures might include dentures, bridges and crowns. Your policy might cover half the cost of a major procedure, and you’ll need to pay the rest.

Coverage Limitations

Some things won’t be covered by your dental plan or have certain limitations.

Cosmetic Procedures

Dental insurance usually doesn’t cover services to improve how teeth look — if it’s not medically necessary. This includes cosmetic procedures like attaching veneers, whitening teeth or installing adult braces.

Time

Services usually come with a time or number limit based on general recommendations. For instance, if experts recommend patients see their dentists twice a year, your insurance might only pay for two preventive visits. Likewise, you might have to spread these visits out — one every six months, for example.

Note that plans often have a waiting period for dental work, which could be several months. You can usually get coverage for routine services and exams right away. But you might have to wait six to 12 months for restorative work, depending on your plan.

Preexisting Conditions

Your dental plan might not cover certain preexisting conditions — when this happens, you have to pay out-of-pocket for treatment. For example, a plan might not cover any services related to missing teeth if you’ve lost some teeth before enrolling in the program.

Cost

Most dental plans have an annual maximum limit, meaning they only cover services up to a certain amount. You pay for anything over the maximum limit.

For instance, your maximum annual limit may be $1,500. You pay for whatever costs you incur after you reach that limit.

Dental insurance plans typically provide adequate coverage if you maintain your oral health and get regular preventive care. Your dentist will work with you to create a treatment plan that reduces out-of-pocket expenses while helping you get the most out of your insurance.

Choosing Dental Insurance in California

We can help you purchase dental insurance in California. You can buy a dental plan through Covered California during open enrollment or during a special enrollment period if you have a qualifying event.

You also have the option to buy a standalone dental plan any time of the year. Ask us for help choosing a dental plan that’s right for your budget and oral health.

We Can Help at Health for California

Having dental insurance can save you money, help you take care of your teeth and address problems early — and it doesn’t have to cost much. At Health for California, we can help you select a dental insurance plan that suits your oral care needs and your budget.

Applying for dental insurance is fast and easy through our site. Get a free quote today to start.