How Dental Insurance Works: Understanding Your Benefits

In this post, we’re excited to discuss a topic that many patients often have questions about: dental insurance.

Looking beyond the basic question of “do you accept my insurance?”, today we’ll be examining the history of dental insurance, explaining how it works, and helping you understand how to interpret your benefit coverage.

We’ll also discuss how our Santa Barbara and Lompoc locations can help you get the best care, no matter your insurance coverage or budget.

Dental insurance has never been the same as medical insurance

Your dental health is extremely important to your whole-body health. But when medical insurance emerged in the 1850’s, dental care was not included. In fact, it wasn’t until 1954 that dental insurance was first introduced.

Dental insurance took off after that, spreading across the US as it gained in popularity. Today, close to 77% of Americans have dental coverage. However, one thing remains the same: dental insurance is still viewed as something separate from medical insurance.

These differences can be seen in a few key ways…

  • Premiums and deductibles
  • In and out-of-network coverage
  • Co-pays
  • Types of covered treatments

This last point — covered treatments — is probably the one you’re most interested in. It’s also the one that causes the most confusion.

What is dental insurance for?

Every person’s plan coverage is a little different, but most dental insurance coverage is grouped in three categories:

  1. Preventive
  2. Basic
  3. Major

Most dental plans cover 100% of preventive care treatment. This typically includes things like your twice-a-year dental checkups with cleanings, x-rays, and sealants.

Basic procedures typically include things like gum disease treatments extractions, fillings, and root canals. Most policies cover 70% to 80% of these procedures, with patients paying the remainder out-of-pocket.

Finally, major treatments like crowns, bridges, imaplants, or dentures are usually covered with a high co-payment — you’ll pay more out-of-pocket for major treatments than you will other types of procedures.

They way treatments are categorized will vary from plan to plan. Additionally, some types of treatments will be included in coverage and others won’t at all. For example, maybe your plan covers tooth sealants but not braces, while another plan covers braces but not sealants.

The most important thing to know is that even if your dental plan doesn’t cover a certain service, it doesn’t mean the treatment isn’t necessary or that you shouldn’t get it.

So how does dental insurance work?

Let’s get to the meat of the subject — how exactly this type of coverage works. Remember, dental insurance doesn’t really resemble medical insurance in the traditional sense, so thinking of insurance as payments to cover the cost of a loss isn’t quite right, either.

Most dental insurance plans operate similar to a cost-savings membership. For example, if you get in a car accident, your auto insurance will pay to fix your car. But if you get a sports accident where a tooth is damaged or broken, your dental insurance will not pay for all of it.

Instead, the cost of repairing your tooth will be split between you and the insurance company. The portion you pay is determined by the type of plan you have, whether the procedure is considered preventive, basic, or major, and whether or not the plan includes that type of treatment.

Finally, the total amount that your insurance company will contribute toward your dental health typically has a yearly cap. It’s like an allowance, and every new year, that allowance bank starts over.

Dental insurance is not meant to dictate your care

The reason we keep mentioning that dental insurance is not the same as health insurance is to help you look at these benefits in a different way. It’s meant to help you afford care, not dictate it.

Yes, price is important to all of us, but equally important is your health. So look beyond the bottom line and consider your dental health as a worthy investment. Use your “allowance” to help make care more affordable, not necessarily cover in full all the care you need to be healthy.

Additionally, your priority should be on finding a dentist you like and who can provide you with the level of care you deserve — not just solely based on whether or not the dentist takes your insurance.

Remember: Regular, preventive care is the best dental insurance there is

At Ericson Dental, we are huge proponents of preventive dental care. We just can’t stress it enough: Good at-home care habits and regular dental visits have a HUGE effect on your health and happiness — and on your wallet.

We mentioned earlier that most insurance plans completely cover preventive care like general exams and cleanings. These appointments allow us to coach you along on your dental health journey, providing very important tips and instructions for maintaining excellent dental health.

Most importantly, regular preventive visits allow for early detection of problems leading to less-invasive, more flexible, and less expensive treatment options.

For example, catching decay when its small may require a simple cavity filling. But when you put off getting a cavity filled, there’s increased risk of infection or further and more expensive damage to your teeth, like a costly root canal.

Get the care you need – whether or not you have a dental benefits or not

No matter what type of dental insurance you have — or whether or not you even have dental insurance — our team at Ericson Dental is on your side and wants to help. We are dental experts at dental insurance and are happy to help you understand your plan, the cost of a treatment, and how much you can expect to pay out-of-pocket.

If you don’t have insurance, we’re proud to offer dental savings membership plan options through Premier Smile Plan. This savings plan allows you to save up to 50% on most dental procedures, including cleanings, checkups, crowns, root canals, and includes routine, major and specialty dentistry.

No matter your financial situation, know that there are options available to you. And at Ericson Dental, your care is never dictated by your insurance coverage. We provide high-quality, high-tech, and personalized care to every single patient.

Contact us with all your insurance-related questions. Or, if you don’t have insurance, ask about our in-office payment plans or learn more about our Santa Barbara savings program and our Lompoc savings program. Even those who do have insurance benefits often find that our savings program provides more benefits than their current carrier.

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