What Treatments Do Dental Insurance Cover?
The National Association of Dental Plans reports that 77% of Americans have dental benefits, but most of them do not know what they cover. If you’re one of those people, it’s time to look at your policy’s fine print to find out what is included and what you will have to pay for out-of-pocket if you require an uncovered dental procedure.
Types of Plans
If you’re shopping around for dental coverage, it’s important to know there are different types of plans. Each plan covers specific dental procedures, and some will absorb all of the costs, while others will only pay for some of them.
The following are the most common dental plans that Americans use:
Preferred Provider Organization (PPO)
This dental plan is like a health insurance PPO. It comes with a list of dentists that accept the dental plan. You can go out-of-network, but your out-of-pocket expenses will be much higher.
Dental Health Maintenance Organization (DHMO)
Like a health insurance HMO, this dental plan has a network of dentists who have agreed to accept this insurance for a set co-pay. Some of the dentists may not charge you anything at all. The only caveat with this dental insurance that differs from PPOs is that you cannot see out-of- network dentists.
Discount (Referral Dental Plan)
This dental plan offers discounts on dental services. The dentists who accept this plan have agreed to provide discounts to patients that have it. This is not through an insurance company, and the company that offers these discounts does not pay the dentists for your dental care as insurance companies do.
General Dental Coverage Information
Preventative care and standard procedures are most often covered by dental insurance. This may include:
Some dental insurance companies will cover some or all of the costs of:
Most dental insurance plans have a cost structure of 100-80-50. This means that they pay 100% of preventative care, 80% of necessary procedures, and 50% of major procedures.
All insurance plans have a cap on how much they will pay per year for your dental care. Caps should be considered when selecting a dental plan because many of them are low. Once the cap has been reached, policyholders must pay out-of-pocket for additional dental services.
Pre-Existing Conditions
Just like with health insurance, many dental insurance companies will not cover pre-existing conditions. You will be responsible for paying for treatment for those conditions. Any new conditions that arise may be covered by the policy you choose.
Pre-Treatment Estimate
It’s always a good idea to read through your dental insurance policy every year to ensure it is covering what you need. If you ever have any questions, the best person to call is someone at the dental insurance company.
Whenever your dentist recommends a procedure, you can request to have him submit a pre-treatment estimate. The insurance company will send back information on how much it will pay for the procedure and how much you will be responsible for after they have paid their portion.
Dental Insurance Plans Our Dentist in Simi Valley Accepts
Our dentist in Simi Valley accepts most dental insurance plans. To find out if we accept yours, contact Dr. Victor Muradian in Simi Valley at 805-522-0880.
Location: 3695 Alamo St #300, Simi Valley, CA 93063
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