Due to the ACA, many health plans have pediatric dental embedded as a benefit, but sometimes the dental coverages do not start until after the medical deductible is met. Plus, pediatric dental is for children under age 19, not for adults. Dental Insurance typically covers basic cleanings upfront (maybe after a small deductible) and then other services are often covered after waiting periods. Once the waiting periods are met, services are then typically covered at a coinsurance rate, up to a maximum limit per year.
Types Of Dental Insurance Coverage
Dental insurance policies are often categorized as either Indemnity or managed-care plans. The major differences are concentrated around out-of-pocket costs, choice of dental care providers, and how bills are paid.
Typically, Indemnity coverage offers a broader selection of dental care providers than managed-care policies. With an indemnity policy, the carrier pays for covered services only after it receives a bill, which means that you may have to pay up front and then obtain reimbursement from your insurance carrier. Usually, managed-care policies maintain their own dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you.
What Is Typically Covered?
You need to look at the fine print of your policy or agreement to find out what your dental insurance covers. In general, basic dental insurance coverage includes three categories:
Preventive and diagnostic dental care: Almost all dental plans and dental insurance policies cover basic dental costs that are meant to prevent dental problems. For the policyholder that means, most plans covers a large part or all the dental costs associated with basic services such as cleaning, checkups, and other dental procedures meant to prevent tooth and gum disease. This coverage is important because it encourage people to seek regular dental care, which can prevent more complicated and costly problems.
Basic dental care and dental procedures: Most dental plans and dental insurance also cover basic dental procedures such as fillings, tooth extractions, fixing chipped teeth, and other such basic procedures. However, basic dental care varies from one provider to another. In general, since providers cover a significant portion of basic dental care, it makes sense to select a dental care insurance provider that covers as many dental care basics and procedures as possible.
Major dental care: While not all dental insurance plans cover major dental care, some do cover at least a portion of these costs. Major dental care can include procedures such as dental surgery, denture work, and other large, expensive dental procedures. If, you will require major dental care at some point in the future, you may wish to look for provider willing to pay for as large a percentage of this type of care as possible.