What Your Dental Insurance Plan Does and Doesn’t Cover


Dental care is essential in maintaining your overall health and well-being. From visiting your dentist twice yearly to practicing good oral hygiene habits, they can help prevent various problems and improve your appearance, self-confidence, and quality of life. 

Sadly, not everyone can afford them because of the lack of financial support and limited access to dental professionals. Fortunately, many employers or group programs provide many Americans with dental benefits through private coverage to make these services more affordable. It may be crucial to pick the right plan for your needs, but you must understand what it covers and doesn’t. 

If you want to maximize your dentist’s services, this article will tackle what your dental insurance will and won’t cover. We’ll also discuss the types of plans, what to consider when getting one, and why you should regularly review premium levels. 

Insurance vs. Benefits: What’s the Difference?

When buying dental insurance, remember that it differs from benefits and understand what the plan covers. Insurance covers the cost of unexpected dental procedures like tooth extractions or root canals. On the other hand, benefit plans only cover certain things fully, some partially, and others not at all. Professionals designed them to be helpful, but they’re not comprehensive. 

3 Dental Plan Categories 

After differentiating dental benefits and insurance, here are three categories of dental plans. 

1. UCR Programs 

Usual, customary, and reasonable (UCR) programs let patients choose their dentist and pay a percentage of the healthcare provider’s fee. However, the plan’s limits may not accurately reflect the actual fees charged by dentists. There’s also no government regulation on determining the UCR fees, leading to significant variation. 

2. Table or Schedule of Allowance Programs

The table or schedule of allowance programs lists covered services with a fixed dollar amount that the plan will pay, regardless of the dentist’s fee. Patients must pay the difference between the allowed charge and the dentist’s fee. 

3. Capitation Programs

On the other hand, capitation programs pay dentists a set amount per enrolled patient in exchange for specific treatments, where some may have a patient co-payment. The amount paid may not match the patient’s actual dental care cost. 

3 Types of Plans 

Dental plans are somewhat similar to health insurance plans but differ in others. This section will enumerate three options you’ll usually encounter when buying one. 

1. Dental Health Maintenance Organization (DHMO)

A DHMO is like a health insurance organization (HMO), where dentists accept the plan for a specific co-pay or may not provide fees. However, if you want an out-of-network healthcare provider, you might not be able to avail this plan’s benefits. 

2. Discount or Referral Dental Plan 

This plan lets you get a discount on dental services from a selected group of dentists, but it doesn’t pay for your care like health insurance. Participating dentists also agree to give you a discount for the care you receive.

3. Preferred Provider Organization (PPO)

While a PPO dental plan has a network of dentists who accept it, you can go out of network for a higher cost. 

What to Consider When Getting Dental Plans

Employer dental coverage is usually cheaper than buying one yourself. If you’re shopping alone, ask your dentist for recommendations and consider factors like in-network providers, costs, coverage for braces and emergencies, and eligibility criteria. 

Why Should You Regularly Review Premium Levels?

Individuals with dental insurance plans and receiving treatment should request periodic evaluations of their premium rates to ensure their payment schedules are fair and reasonable. This assessment can assist in maximizing the benefits and ensuring that they use all expenses efficiently.

Getting the Best Coverage and Dental Care

Everyone deserves proper dental care, regardless of their employment status and financial capabilities. You can buy the right dental insurance plan by considering your options and consulting your dentist. 

If you’re looking for a professional dentist in Sudbury to discuss dental insurance plans, visit Sudbury Dental Arts! We’re committed to delivering quality, affordable services to help our patients smile better. Contact us now to learn more!



More Posts