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Buyer's Guide

Buyer’s Guide for Dental Insurance and Discount Dental Plans

Browse Common Concerns:

Determine Your Needs for the Future

Most people shopping for dental insurance on the Internet fall into one of two broad categories of needs:

  • those WITH an immediate need and
  • those with NO immediate need.

And while it’s true that dental insurance is for the unexpected, when you’re shopping for a plan, it helps to have some idea of the type of procedure you may need in the future.

Example: A common problem with the older-type of fillings used in molars is that as a tooth ages, the chewing and grinding pressure placed on those old fillings actually acts like a wedge, splitting the crown of your tooth apart. Your last dentist, therefore, may have told you that you will SOON need crowns to replace the teeth being split apart by the old fillings. In this case, knowing that you need a crown (or crowns) soon, you would probably look for a policy with a shorter waiting period for crowns.

Why do dental insurance companies have waiting periods? It’s the nature of dental care that most people do not need expensive care very often. If insurance companies did NOT impose waiting periods, it’s just human nature that individuals would be inclined to join a plan, get whatever expensive procedure was needed and then quit the policy so he or she would not have to contribute any more premium to the plan. Then, the next time that individual needed an expensive procedure, the cycle would be repeated. Waiting periods ensure that you are “invested” in the policy, that you and your fellow plan members have paid enough into the insurance pool that all members are covered when they need it. 

When you are looking at what procedures a particular dental insurance company covers and how long you have to wait for them to be covered, keep in mind that insurance companies generally divide dental care into three categories based on relative cost. If you think about it, it makes sense: a cleaning, while crucial to good oral health, requires less expertise or training than gum surgery. Therefore, much, if not all the cost of a cleaning is usually covered by all plans as soon as your effective date. The following is a general guideline for how most dental insurance companies separate their covered procedures.

1. Preventive Care or “Cleanings”

Preventive care is also commonly described as “cleanings” but it actually represents several vital steps that, together, furthers the care of your teeth and gums and lets your dentist assess the condition of your teeth and gum tissue. Because it’s most important to prevent dental problems from ever starting or allowing a small problem to develop into a big problem over time, most dental insurance pays for your preventive and diagnostic care—twice a year—in full. Especially if you are buying coverage for a big family, having your preventive care fully covered twice a year can save a lot of money over time. If this is your situation, you may want to make sure you choose a plan that pays for preventive care in full immediately. X-Rays to detect decay, tumors, cysts, bone loss, tooth and root positions are typically done once a year.

Here’s a list of preventive care items which may be performed every six months. (Please check the plan details of each plan you are considering before you buy.):

  1. Gum disease evaluation
  2. Tooth decay screening
  3. Oral cancer Screening
  4. Evaluation of existing fillings and crowns
  5. Tartar removal above and below the gum line
  6. Plaque removal
  7. Polishing
  8. Home-care instructions, if needed
  9. Fluoride treatment

2. Minor Procedures/Basic Care

Minor or basic care is anything done that normally is considered routine and doesn’t require surgery. Dental health maintenance organizations typically cover minor procedures as soon as your policy becomes effective with no deductible. It is normal for preferred provider organization and indemnity plans to have a waiting period of six months for these minor procedures and to require you to meet a yearly deductible before the plans begin to pay.

Care which is common to this category may include but is not limited to:

  • Fillings
  • Simple extractions
  • Repairs to existing crowns, dentures and bridges

3. Major Procedures

A major procedure may involve sedation, building a dental appliance or surgical procedures. Dental health maintenance organizations normally cover major procedures as soon as your policy becomes effective with no deductible. It is normal for preferred provider organizations and indemnity plans to have a waiting period of between 12 and 18 months for major procedures and to require you to meet a yearly deductible before the plans begin to pay.

This list of procedures may include but is not limited to:

  • Partial plates
  • Dentures
  • Root canals
  • Extraction of impacted wisdom teeth
  • Gum surgery
  • Crowns

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