What Is Dental Insurance?

Dental insurance is insurance that provides coverage for dental expenses, such as those rendered by dentists, orthodontists, periodontists and other medical care providers. Traditional health insurance rarely covers dental expenses, thus the need for separate dental policies. 

Dental plans exist as individual plans, family plans and group plans. Group plans are most likely to be offered at your place of employment. However, it is less common for employers to offer dental plans to retirees, but the need for dental coverage continues throughout retirement.

Coverage 
Dental insurance coverage varies according to plan. Basic procedures include fillings, oral surgery, periodontics, endodontics and preventive treatment. Some plans offer preventive treatment for free. Major procedures usually include dentures, crowns, implants, cosmetics and some surgeries. 

Plans usually have limits on the number of dental visits and treatments that are covered. Some plans do not cover pre-existing conditions, and some plans only cover the least expensive option for a given treatment. 

Fee schedule 
Dental insurance companies have a fee schedule—a list of prices that they will pay for dental services and products. This schedule is based on what is called "usual and customary dental services." Dentists have fee schedules of their own, but when they contract with a dental insurance company, they agree to charge the insurance company's prices, which are almost always lower. Though they are getting paid less, they can usually count on drawing in more customers because of the lower cost and because the plan makes referrals to them. 

Once a dentist has accepted the insurance company's prices, they become an "in-network provider." If you have your coverage with this company, you are expected to use in-network providers. Some plans let you use out-of-network providers, but you will have to pay some or all of the cost of them, unless your insurance policy specifies otherwise. 

Waiting periods and maximum benefit limits 
Some dental insurance companies have waiting periods, in which you must wait a certain length of time before a service is covered. They may also have annual benefit limits, meaning they cap the amount that will be covered each year. At the end of the year, the cap disappears and the annual benefit limits start over. 

As with traditional health insurance plans, there may be a deductible. There may also be separate annual benefit limits for different types of services (for example, orthodontist services). Finally, there may be co-pays. 

Costs for coverage 
Dental insurance costs vary depending on the type of plan and how much coverage is offered. Costs are well below those of regular health insurance. 

Back to Benefits Homepage