Understanding Dental Insurance
Hello everyone. Dr. Virginia Ellis here at Virginia H. Ellis, DDS Dental Corp.. Today I'm going to talk about dental insurance. I've received many questions about dental insurances, so let's dive right into it.
Dr. Ellis, what is dental insurance, and how does it differ from standard medical insurance?
Well, dental insurance basically deals with your mouth and your teeth, whereas medical insurance deals with the rest of your body, your head, neck, and everything else. Dental insurance covers only the inside of your mouth, your tongue, your teeth, and that's about it. Anything outside the mouth is medical insurance.
How much is dental insurance on average, and what factors have an impact on the cost?
I'm going to give you a rough estimate. An average dental insurance can cost anywhere between $25 to $50. What can impact the cost? Basically, the coverage and what determines what's going to be covered on your dental insurance is usually determined by what your employer negotiates with the representative of the dental insurance company. That's why one insurance company might pay more for a crown than another company. It is what the employer and the representative from the dental insurance negotiate with each other.
What are the best dental insurance plans for major dental work or extensive procedures?
The best dental insurance plans? None. They're all the best of the worst. Insurances are not designed to cover everything in your benefit, or they wouldn't stay in business. But I think they often go overboard in covering as little as possible. The best of the worst would be Delta Dental, Spirit Dental, Guardian Direct, and MetLife. A lot of times they can have no maximums, but it really depends on what's covered.
Again, it depends on what your employer gives you as a benefit and what they have negotiated with the dental company. Don't expect dental insurances to pay major portions for your dental needs. It's not designed that way. Think of it as a coupon. A coupon isn't going to pay for a major portion of something that you're buying or a service that you're getting.
How does dental insurance work for specific treatments like braces, root canals, or dental implants?
That varies depending on the type of dental insurance you have. Generally speaking, dental insurances don't usually cover braces for the most part. A few do, but if you have dental insurance that does cover braces, that's great because many don't. When they do cover braces, they'll usually pay in increments, not paying the doctor's office all at once. They'll pay a certain amount every few months until their maximum for that coverage is paid.
Regarding root canals, many dental companies will pay anywhere between 40% to 80%. For implants, there can be limitations. Sometimes insurance companies have clauses like a missing tooth clause, which means if you come in with a missing tooth when you get the insurance, they won't cover an implant for that tooth. But if you have a tooth and lose it later, they might cover it. Always ask the 800 number or the dental office. In my practice, we do a complimentary benefits check to maximize your insurance benefits, but you have to show up as a new patient.
Is dental insurance worth it for routine dental care and cleanings?
That's a very good question. It depends on the type of plan you have. You'll need to do the math. Many plans are designed so that you're essentially paying for your own dental cleanings and exams. Don't think you're coming out ahead. You can, but most of the time you don't. You really benefit from dental insurance if, for example, you have a year where you break a tooth and need a crown or root canal. Most dental insurances will have benefits anywhere between $1,200 to $1,800 a year. Dental insurances haven't increased their coverages since the 1960s, so $1,800 was a lot more back then than it is now.
What dental procedures are typically covered by medical insurance versus dental insurance?
Dental insurances cover things like cleanings, x-rays, exams, fillings, root canals, crowns, sometimes implants, and sometimes braces. Medical insurance covers things outside of the mouth. Anything inside is usually dental-related, but everything else outside is usually covered by medical insurance. Medical insurance is outside the mouth; dental is where your teeth are, inside your mouth.
Can you explain supplemental insurance and when someone might need it?
Supplemental insurance is extra insurance to cover gaps. For example, if your insurance only covers $1,200 a year, you might buy extra insurance to cover another $1,200 or more. Be careful about duplication clauses, as they might not cover the same treatment twice. If you need a crown and one insurance covers part of it, the second might only cover the remainder or have other specific limits. Deductibles might also apply. The best thing to do is to call us when you come in, and we can help you understand and maximize your insurance benefits.
How can patients find affordable dental insurance that fits their needs?
You should figure out what you need and carefully read through the insurance details before signing up, as many people find out too late that their insurance covers very little. Determine what your insurance covers, what you'll need for the year, and decide if it makes financial sense.
Is it possible to have dental insurance policies, and how does coordination of benefits work?
Yes, that's dual coverage. Your primary plan will cover what it can, and your secondary plan will pick up the rest, but only to a limit. If you have a $2,000 crown and your primary plan covers $800, your secondary insurance might cover the remaining amount, but not beyond certain caps. They're designed to pay as little as possible.
How should seniors choose the best dental insurance for their individual needs?
Medicare does not cover dental; it's considered medical insurance. Many older people stop working and lose their dental insurance, so they pay out of pocket. If you can find dental insurance, try not to choose one that limits you to a network of dentists. As you age, dental needs become more complex and require more experienced dentists. Mature individuals often need more specialized care.
Can Virginia H Ellis DDS Dental Corp help me find financing options so that I can get the dental care that I need?
Yes, we will. We submit claims for you if you have dental insurance. If you're about to start a new job or change insurance, call our front desk and talk to our insurance coordinator. She can help you understand what your insurance covers, allowing you to make informed decisions about the best dental coverage for you and your family.
How can I get started with dental financing?
Ask the front desk. Call us, and we will guide you. We'll provide guidance on options. If you have questions about your insurance company, we're happy to help. We are patient-driven, not insurance-driven. We work on your behalf to help you get the best dental work and experience to meet your dental needs.
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We accept the following financing:
5% Discount for cash or check payments at the time of the service.
* Not related to insurance.