What’s the deal with Dental Insurance?

Do you have questions or concerns about dental insurance? What does it cover? How does it really work? Do you need it? You are not alone. Many people express some confusion with dental insurance and don’t know where to go for answers.

Family Dentistry of Lakewood wants to assist you in obtaining answers to your much needed questions and help you determine if you are getting the most out of your dental benefits. We also want to offer choices if insurance is not an option for you.


One of the most important factors to understand about dental insurance is that it’s not the same as medical or even auto insurance. Dental insurance is often called dental benefits because the coverage works significantly different than medical insurance. A benefit plan is set up to cover certain costs. It may cover some procedures fully and then only a percentage of other procedures.


Dental insurance policies can put a large financial responsibility on you, and some policies will limit the number of times you can have specific procedures. The policies will also have an annual maximum payout. So, once you have reached the maximum amount you will be responsible for the rest of your oral health cost.


This transitions us into another important element to consider when thinking about dental benefits. Many times, for a few dollars more a month you can significantly increase your benefits. For instance, a few more dollars could mean the difference in deep cleanings covered at 80% instead of 50%, or twenty-one x-rays instead of four.


Another point to consider is the importance of taking ownership of your oral health. Dental insurance plans are not set up to benefit everyone, so you need to make sure you understand the type of benefits you need and find a plan to meet your needs.


Some patients and dentists are dental insurance driven, focusing on areas of their oral health that are covered by their dental policy. For instance, someone has periodontal disease, but they only want their dentist to do a regular cleaning since their insurance doesn’t cover a deep cleaning at 100%. Being insurance driven in your oral or medical health is a dangerous choice and it’s advantageous to consider a policy that provides better benefits.


Typical Dental Insurance Policy Breakdown

Even with all this new information you may still be wondering how to choose the best dental plan for your needs. During your research, you will notice there are some basic elements offered by most companies.


Below is a breakdown of a typical dental insurance policy:

● 100% coverage for class 1 preventative and diagnostic care such as exams, regular

cleanings, x-rays, and fluoride treatment

● 80% coverage for class 2 basic care including root canals, extractions and oral surgery

● 50% coverage for class 3 major services not limited to crowns, dentures, and implants


It is important to confirm that the coverage includes at least two cleanings per year, one set of x-rays per year, and some form of emergency coverage. Make sure you ask specific questions to determine if the plan meets your needs.


Here are some beneficial questions to ask when researching and speaking with dental insurance companies:


● Is pre-approval required for specific procedures?

● What is the annual maximum the plan pays?

● Can you choose the dentist you want?

● What is the total cost for the plan including premiums and co-payments?

● Is orthodontics included in the plan?

● What type of coverage is available for emergency treatments?

● Are there any pre-existing condition clauses? Waiting periods? Missing tooth clause?

● Is my coverage limited to the least expensive available treatment options or downgrades?



Consider these tips when choosing the best dental plan for your needs:

● Read the policies fine print because not all services are covered.

● Check with your current dentist when choosing a plan since they may not accept your

policy.

● Preventative care is the priority, so most policies will be heavy on preventative services.

● A deductible is likely with most policies so be prepared for a possible cost when visiting

the dentist.

● Shop around for the best coverage because prices vary from company to company.

● Review your coverage and check in annually to confirm your insurance provider continues

to meet your needs.

● If you need orthodontic care, make sure the plan you choose covers your needs.


Hopefully you are gaining beneficial insight to help you, but what if you can’t afford dental insurance or it’s not an option for you? Family Dentistry of Lakewood offers a Wellness Program for our patients who are unable or choose not to acquire dental insurance. Below is more information to help you determine if this is the right option for you and your family.



Family Dentistry of Lakewood understands how intimidating and confusing dental insurance can be when searching for a policy that meets your needs. If you are looking for a new policy or want more clarity on your current policy, please call our office at 253.584.3121 and we can do a quick dental audit over the phone. We will walk through your current plan and help you determine if it is the best option for your needs.


Family Dentistry of Lakewood wants to help you navigate through the confusion of dental insurance and feel confident about the choices you make for your oral health. We look forward to hearing from you.


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