Dentist in Portland | Dental Insurance Doesn’t Have to be a Headache

Understanding a Few Principles Will Help You Navigate Your Dental Insurance

Downtown Dental Associates of Portland

Maybe you’ve spent hours poring over your dental insurance policy and have a firm grasp of what it covers and how to get the most benefit from it. Maybe you’re like the 99 percent of us who simply put aside the policy to review at some later date that never comes.

Don’t worry. The staff members at Downtown Dental Associates of Portland have some answers for you that will help you navigate your dental plan and help you make the most of it.

Once you wade in, you’ll find that dental insurance is a lot easier to deal with than, say, your health insurance. There are just a few things you need to understand to get your head around it.

Let’s go over a few terms that will help:

Deductible — This is the amount, usually $25 or $50, which is paid by you at your first appointment for a particular treatment, a crown or filling for instance. It’s important to note that most insurance companies don’t make you pay a deductible for exams or cleanings because these are maintenance and not treatments, technically speaking.

Annual Maximum Benefit — Just like its name says, this is the total annual amount that you can claim under your dental insurance policy in a benefit year or calendar year. Knowing this amount and discussing your treatment plan with your dentist will help you plan accordingly, so you get the most benefit from your insurance.

Under most dental plans, the annual maximum benefit is usually $1,000 to $1,500 and is paid out in percentages, depending on what services you are receiving. Though the percentages vary by dental insurance company, one example is a plan that offers 100/80/50 percent coverage for various services and treatments.

For example:

  • Preventative services such as exams, x-rays, cleanings, fluoride treatments and sealants for youngsters are covered 100 percent in some plans.
  • Basic restorative procedures, such as fillings, root canals, extractions, periodontal scaling and other deep cleaning, are usually covered at 80 percent by some insurance companies and 20 percent by you.
  • Major restorative procedures — such as crowns, posts, dentures, buildups and bridgework — can be a 50-50 deal with you paying half and the insurance paying the other half.

Again, these percentages vary by company and plan.

There are other parts of dental insurance policies that you want to look out for and understand, and these are called exceptions. These are rules in the policy that put a waiting period between when you join a plan and when you can receive your first treatment. Not surprisingly, these are called waiting periods and can be as long as six months. You also want to look for exceptions such as a missing tooth clause that prevents you from getting bridge work or dentures for a tooth or teeth that were missing prior to your joining the plan.

These basics should help you begin to understand your dental insurance, but we also want you to remember that you can ask us what different terms of your policy mean and how they could affect payment.

The most important thing to remember is that your dental insurance policy is a lot like a gift card. There’s an amount you can use, but if you fail to use it in a particular time frame, you lose the benefit. Unlike a gift card, though, use of dental insurance can help you maintain and even improve your general health.

Talk to us today at Downtown Dental Associates of Portland about how we can help you make the most of your dental policy — and your dental health.