In an ideal world, dental insurance would cover everything that you need done. Alas, that isn’t the case. While the insurance will cover some of the brunt of the cost, there are times that you will have to pay a good amount of money on some procedures. The fact that you would have paid even more for this without the procedure will likely be cold comfort. Still, there are several choices out there for you to make in terms of coverage. There will be several factors involved too, so it might wind up making you have to choose the one that is less painful overall.
There are several types of plans to choose from – and going in-depth on those could be an entire blog post in itself. Basically, though, there are three that you have to consider – HMO, PPO or Indemnity plan. The HMO wants you to to use a dentist that’s within their network. The PPO plan gives you more flexibility in choice and the dental savings plan means people can pay a lower cost for a procedure, but that will be out of pocket. There are also dentists who have financing plans.
Typically, a plan will cover 100% of the cost of your twice yearly routine visit, 80% of basic procedures like root canals or fillings and 50% of the cost of more advanced procedures like crowns, bridges and implants. That 50 % can still be quite expensive, but imagine not having the coverage and having to pay all of it?
Another thing you need to consider when you’re looking over the plans is what the deductible is. You need to pay a certain amount before the insurance starts paying. If something’s $150 and your deductible is $200, you’re still paying for the whole thing. While it’s impossible to accurately predict any emergency procedures, see how much you often spend on dental visits per year and weigh that against the deductible.
A very important item to keep in mind is that, barring circumstances like braces, the insurance companies will not cover cosmetic dentistry. That includes things like teeth whitening. If you want to have these things done – self-esteem is very important, after all – you will more than likely wind up paying for all of it. Even orthodontics would have to be considered on a case-by-case basis to determine if the insurance will pay for it.
Once you’ve paid the deductible, the insurance will pay a percentage of anything that’s above it. They won’t cover the whole cost, but it will be less than what you would have paid had you not had any insurance at all.
There will also be a maximum amount that the insurance will cover – and once you’ve reached that limit, anything that is above it, you will be paying for out of pocket.
Dr. Robert Trager is glad to work with all kinds of patients in the Queens area – there’s a reason he calls himself the JFK-LGA dentist. His courteous staff will gladly answer any insurance coverage questions for you. Make an appointment today!