Dental insurance can be confusing if you’re not familiar with the terms. Whether you’re reviewing your current plan or shopping for a new one, understanding key definitions can help you make better decisions. Here’s a simple guide to common dental insurance terms and what they mean:
1. Preventive Care
This includes routine services designed to keep your teeth healthy and catch issues early. Think cleanings, exams, and fluoride treatments. Most plans cover these at 100% with no deductible.
2. Diagnostic Care
These are services used to identify dental problems, like X-rays and oral evaluations. They often go hand-in-hand with preventive care and are typically covered fully or at a high percentage.
3. Basic Services
This refers to treatments like fillings, simple extractions, and certain types of periodontal work. These usually require a copay or coinsurance and may be subject to a deductible.
4. Major Services
More complex procedures like crowns, bridges, dentures, and root canals fall into this category. Coverage for these services is typically lower and may include waiting periods.
5. Orthodontics
This includes treatments to straighten teeth, such as braces or clear aligners. Not all plans cover orthodontic care, and when they do, it’s often limited to children and subject to separate limits.
6. Deductible
The amount you must pay out-of-pocket before your insurance starts to pay for services. Preventive and diagnostic care often bypass the deductible, but basic and major services usually do not.
7. Annual Maximum
This is the total amount your dental insurance will pay in a year. If your dental costs go beyond this limit, you’ll need to cover the rest.
8. Copay
A fixed amount you pay for a specific service. For example, you might pay $20 for a cleaning, while the plan covers the rest.
9. Coinsurance
A percentage of the cost you share with your insurer after meeting your deductible. For instance, if your plan covers 80%, you pay the remaining 20%.
10. Waiting Period
Some plans require you to wait a certain amount of time before covering major services or orthodontics. Make sure to check this if you anticipate needing more extensive care.
Final Tip:
When comparing dental plans, always look beyond the monthly premium. Understanding these terms can help you find a plan that truly meets your needs and avoids surprises when you visit the dentist. Visit our Providers page to see our recommended carriers and plan details.
