Insurance FAQ’s
Understanding How Dental Insurance Works
There are a few main terms that you should know to better understand your dental insurance and how your coverage works:
- Maximum: Your maximum is a capped-off amount of money that your insurance will pay for dental treatments over the course of a calendar year.
- Deductible: The deductible is a set amount of money that your insurance requires you to pay out-of-pocket before your benefits will kick-in.
- Premium: The premium is the monthly or annual amount you pay for your benefits.
- Coinsurance: The percentage of costs you pay after meeting your deductible, while the insurance covers the rest.
What Does My Dental Insurance Cover?
It’s important to keep in mind that every dental insurance plan varies, and to make sure that yours covers the treatment you need it to, you’ll need to call your insurance company directly. However, most plans determine coverage based on a 100-80-50 structure. This means that they cover 100 percent of the cost preventive care, like checkups and cleanings, 80 percent of basic treatments, like cavity fillings, and 50 percent of more serious procedures, like tooth extractions.
What If My Insurance Plan Is Out of Network?
Many patients assume that choosing an out-of-network provider means higher costs or limited coverage, but that’s not always the case. In fact, some out-of-network plans still provide 100% coverage for preventive care. While insurance companies often promote in-network options, going out-of-network gives you the freedom to select a dentist who prioritizes your health and personalized care—without being restricted by insurance guidelines. Our team is committed to helping you maximize your dental benefits and navigate your coverage effectively. If you have an out-of-network plan, we’re happy to answer any questions to ensure you fully understand your options.