Dental plans typically include a deductible, most likely in the range of $25-50. A deductible is the amount that a member is required to pay before insurance benefits kick in. For example, if an individual deductible is $50, that member is required to pay for the first $50 of dental care before taking advantage of dental insurance. In most plans, but not all, deductibles are waived for Diagnostic & Preventive services. Why? Well, insurance companies want members to go to the dentist and get checked out and prevent major issues. Makes sense, right?
Additionally, plans will include a maximum payment, usually just called a maximum. The maximum is the highest dollar amount that a dental plan will cover in a given amount of time for an individual member. With an annual maximum of $1500, the dental plan will cover up to $1500 of dental services per person, per year.
The next important concept you’ll want to make sure you understand are dental insurance service classes and how they differ from one another. The term service classes refers to the four broad categories of dental care, which are usually covered at different levels by dental insurance. These categories are:
Diagnostic & preventative
- Basic services
- Major services Ortho
Diagnostic & Preventative: For many people, the majority of visits to the dentist will fall under the category of diagnostic & preventative, so let’s go over that first. Diagnostic & preventative covers many of the services a person receives during a routine visit to the dentist. Exams and cleanings are almost always included in diagnostic & preventative, and basic x-rays usually fall into this category as well. Diagnostic & preventative is typically covered at 100%, and often does not require the deductible to be met (but read the fine print!).
Basic Services: If you’ve ever seen a dentist for anything other than a routine cleaning and check-up, chances are you’ve received some form of basic service. Services such as fillings, basic gum disease treatment, extractions and sometimes root canals are typically included under basic services. Basic services are usually covered at 80 or even 90%, meaning a member could pay as little as 10% of the cost.
Major services: This service level covers more complicated procedures, such as complex oral surgeries, dentures, implants, and crowns. Coverage for major services is typically more limited, but if major services are a priority, you can find a dental plan with coverage at up to 60%.
Orthodontics: If you had braces as a teenager or are the parent of a teen with braces, this category is probably (too) familiar to you. Ortho refers to braces associated treatments, and when it is included, is typically covered at 50%. The caveat here is that ortho often includes an age limit of 19, meaning that people over 19 years old are not eligible for orthodontic coverage.
Keep in mind that the descriptions above can differ depending on individual plan design. For instance, fillings are typically included in basic services but are sometimes considered major services, and basic x-rays are usually considered diagnostic & preventative but fall under basic services in some plans
And there you have it! If you’ve made it this far, you should be able to look over a dental plan and understand the majority of what’s going on. There’s still more to dive into, but we’ll save that for next time.