You need dental treatment, so it’s a good thing you have dental insurance, right? Or maybe it would be, if you understood how your policy worked. You’re not alone if you find your dental insurance benefits confusing! Part of the struggle is knowing what some tricky terms actually mean. Keep scrolling, and you’ll become more familiar with four common dental insurance words that everyone should know.
“Co-Payments” and “Coinsurance”
These two terms are very similar, which is why they’re easy to confuse. Both have to do with the amount you’ll pay out of your own pocket for a given service, so keep that in mind and understanding the difference will be a bit simpler.
- A co-payment is a set cash number. Whatever amount is listed in your policy will be what you’re expected to pay after a given treatment.
- Coinsurance is a percentage. The specifics may vary from plan to plan, but just as example, if your policy has an “80/20” coinsurance, your dental insurance will cover 80% of your treatment costs, and you’ll pay the remaining 20%.
“Deductibles”
Similar to other types of insurance, a deductible is the cash amount you’ll have to spend on dental services before your dental insurance coverage kicks in. Fortunately, most dental insurance plans don’t require you to hit your deductible for preventative care coverage. That means that for plans with this policy, you would always receive coverage for checkups, cleanings, and X-rays.
“Annual Maximums”
Understanding your annual maximum is crucial for strategizing your dental insurance benefits. Essentially, your annual maximum dictates how much money your dental insurance company is willing to spend towards covering your treatments in any given year. If you go over that mount, you’ll be financially responsible for paying what’s left of the bill and any other treatments for the rest of the year.
Dental Service Categories
Dental insurance policies generally don’t allocate the same amount of coverage to every service your dentist provides. To help them determine your coverage for a given treatment, they divide dental services into three categories:
- Preventative care services receive the highest percentage of coverage – 80% to 100% on average.
- “Basic” treatments include restorations like root canals and fillings. Typically, about 70% of these costs are covered by dental insurance.
- “Major” procedures usually involve fabricating custom oral appliances, such as crowns and dentures. These expenses are only covered by up to 50%.
If you’re not sure which category your treatment will fall under, don’t be afraid to ask your dentist. In fact, many practices are willing to help you navigate your dental insurance benefits so you can get the most out of your plan. When something doesn’t quite make sense with your policy, ask your friendly dental team for assistance!
About the Practice
Dr. Praveena Muddana and Dr. Sumit Chanana believe that building trust with their patients is essential to providing quality dental care. That’s why they go out of their way to get to know their patients and uphold a dental insurance friendly practice. If money is getting between you and the dental treatment you need, contact Dr. Muddana and Dr. Chanana’s office at 262-563-9100. They and their team will do their best to work with your budget!