If you are fortunate enough to be able to choose between several dental plans, here are things you need to know to make the best decision.

Dental plans either pay a fixed amount for a particular procedure or a percentage of the cost. If you choose a plan with a fixed amount for each procedure, you’ll end up paying something at every visit. If you go with the percentage plan, you normally will not pay for basic coverage (cleanings, exams, x-rays, emergency visits) and you’ll pay a percentage of the cost for the other procedures.

The yearly maximum is the most money that your dental insurance will pay within a full year. It automatically renews every year. Most dental insurance companies allow an average yearly maximum of around $1,000-$2000. I would highly suggest choosing a plan with $1500 or more if you know you are likely to need a filling or some other dental work throughout the year. If you are the type of person who only gets a cleaning twice a year, you’ll be fine with $1000 per calendar year maximum.

Many dental insurance plans have contracts with individual dentists. You can check before your appointment if we are in/out of network. To give you the most options, choose a plan that pays the same to dentists that are in or out of network.

waiting period is the length of time an insurance company will make you wait after you are covered before they will pay for certain procedures. If you choose a plan with a waiting period, you will not get covered during that time for a dental emergency and you might end up paying more in premiums waiting a year than you would have paid out of pocket upfront.

More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” A missing tooth clause means the insurance company will not pay for a bridge, partial, or implant if you lost the tooth previous to starting with that insurance company.  If you have a tooth that’s been pulled or a current bridge, partial, or implant, I would highly discourage you from signing up for an insurance plan with this clause. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as crowns, dentures, partials or bridges until the specified time limit has passed. This is more common and is usually not as big of a problem.

Lastly, check and see if the dental plan covers fillings on posterior composites. Often, a plan will have an amalgam allowance written in fine print: “Covered only for single surfaces, multi-surfaces will be processed as a silver filling and the patient is responsible up to the submitted charge.” That means that your insurance will only pay for an amalgam (silver) filling and if you want or need a composite (white) filling you will have to pay a lot more out of pocket. If you can choose a plan that covers posterior composites, I would definitely choose that plan.

Not everyone understands that dental insurance is not at all similar to medical insurance. The majority of dental insurance plans are designed with the purpose of only covering the basic dental care around $1,000 to $1,500 (about the same amount that they covered 30 years ago) per year and is not intended to provide comprehensive coverage like that of medical insurance. It can be tricky deciding which plan to enroll. If you have questions, please come in for a consultation to see what kind of dental work you might need. Then you can work with our office manager to choose a plan that will best fit your needs and budget.

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