Answers to your top dental insurance questions

Shopping for dental insurance is tricky; there are a lot of things you have to consider when finding a plan. This guide is designed to answer some typical questions. By the end of this, you’ll have an idea of what to look for or ask to find the best dental plan to fit your needs.

What does in-network / out-of-network mean?

  • -If a dentist is in-network with an insurance plan, then it means they have agreed to charge pre-negotiated rates, set by the insurance company, for every service covered under the plan. If a dentist is out-of-network, then it means that they will charge their price for each service.
  • -Pre-negotiated, in-network rates are typically about 50% cheaper than going out of network. Additionally, most insurance carriers will only pay their in-network rate for out-of-network services. That means that you’ll get a bill in the mail for the difference.
  • -You’ll save the most money on your dental care if your dentist is in-network.

What is an Annual Maximum Benefit?

  • -This is the most the insurance company will pay out toward your dental bills per person per year. If, for some reason, your bills are higher than this over the course of a calendar year, then you’ll have to pay the rest out of pocket.

  • -Typically, this can range from $1,000 to $2,500.

What is a Waiting period?

  • -With some plans, you have to wait to take advantage of your coverage. A waiting period is the amount of time you would need to be enrolled in a plan before the insurance company will pay for specific services.
  • -Typically, dental plans have waiting periods between 6-12 months for major services like root canals, crowns, bridges & oral surgery.
  • -There are plans that do not have waiting periods. In return, they are typically more expensive monthly.

WHY are there waiting periods?

  • -At first, it seems unfair that you have to pay for your plan for months before you can use it. However, there is a reason for waiting periods.
  • -Waiting periods exist so people can’t take advantage of the system. Without waiting periods, someone could, theoretically, find out they need something like a root canal, sign up for a plan right before the procedure, then cancel the plan and get the procedure covered for the price of 1 month’s premium.
  • -The threat of the above would add a lot of extra risk to insurance companies, which would force them to charge more for premiums. Waiting periods keep monthly payments lower for everybody.

What types of services are covered under dental plans?

  • -Preventive Services – These includes routine cleanings, bitewing x-rays, and sometimes whitening. Dental insurance will typically pay for 100% of preventive services.
  • -Basic Services Simple tooth extractions, cavity fillings, panoramic x-rays, etc. Most often, these are covered between 60% and 80%.
  • -Major Services – Oral surgery, crowns, root canals, bridges, dentures wisdom tooth extractions, etc. Anything more extensive or involved than a simple extraction is a major service. These are typically covered at 50%.
  • -Orthodontia – Braces. Unfortunately, orthodontia is not normally included in plans. Most insurance companies will not pay for ortho if you are over the age of 18.

How do I find a dental plan?

  • -You could look for one on your own. However, you will need to be careful not to choose a plan that doesn’t cover your dentist or any potential benefits that you might need.
  • -For the best results, you should work with a licensed broker. The brokers at Apollo Insurance Group can help you find the best plan for your life at the lowest price.

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