Understanding Your Dental Insurance

How Dental Insurance Works

Understanding how dental coverage works can help you make the most of your plan. Unlike medical policies, which typically focus on treating illness or injury, dental plans are usually designed around preventive care and have annual limits. Many insurers offer two common plan types: HMOs and PPOs.

With a Health Maintenance Organization (HMO), you choose a primary dentist from a specific network and typically pay lower costs, but your options are more limited. You have to select a primary dentist for your dental care with an HMO. You will need a referral to see a specialist, such as an endodontist or oral surgeon.

A Preferred Provider Organization (PPO) offers greater flexibility, allowing you to visit a wider range of providers. However, fees and premiums are usually higher. You do not need a referral to see a specialist. Comparing the two usually comes down to whether you prefer lower out-of-pocket costs or greater freedom to choose your dentist.

Dental plans often include a “use it or lose it” feature, meaning unused annual benefits don’t carry over into the next year. Because of this, staying on top of preventive appointments is the best way to make the most of your dental insurance.

In-Network vs. Out-of-Network: What’s the Difference?

“In-network” dentists have agreed to discounted rates with your insurer, leading to lower costs for you. “Out-of-network” providers may still be available, but you’ll likely pay more because their fees haven’t been negotiated with the insurance company. As a result, your out-of-pocket costs may be higher.

Accepted Dental Insurance Plans

We accept most private dental insurance plans as out-of-network dentists. However, we are in-network for two of the largest dental insurance providers in the area:

We are in-network as Delta Dental dentists in Wright County and in-network as Wellmark dentists in Wright County. Dr. Anderson is proud to be recognized as one of the finest PPO dentists in Iowa, providing care to patients with private insurance as well as those with some Medicare Advantage Plans.

Key Dental Insurance Terms to Know

Understanding how insurance works begins with having key dental insurance terms explained clearly.

• Annual Maximum: The total amount your dental insurance will pay toward any dental work for you or your family during a calendar year.
• Benefit Year: The 12-month period during which you or your family are covered for dental care.
• Coinsurance: A percentage of the cost of care you are responsible for after meeting your deductible. If your insurance pays 80% of everything after the deductible, your coinsurance is 20%, which you are responsible for paying.
• Copay: A fixed fee you pay for a specific service, usually determined for in-network providers. For instance, you may always pay $25 for an office visit. It is a flat fee, unlike coinsurance, which is a percentage of the total bill for a procedure.
• Deductible: The amount you have to pay for dental care before your dental insurance begins to pay for anything. If your deductible is $500, you will have to pay $500 for any dental care before your insurance begins to pay.
• Exclusions: Procedures that are not covered by your dental insurance plan. Cosmetic procedures such as teeth whitening are typically not covered by dental insurance.
• Preventive Care: Dental care, such as checkups, cleanings, and X-rays, that help prevent cavities and other oral health problems. Dental insurance typically focuses on covering this type of care to avoid more expensive, detrimental dental health issues.

Estimating Your Out-of-Pocket Costs

Knowing how much you will pay for dental care can help you budget accordingly. If we have suggested a specific course of treatment, estimating the cost to you is easy if you follow these steps:

1. Request an itemized treatment plan with the costs from our office.
2. Check your dental insurance for your deductible, coinsurance or copay, and whether the procedure is covered.
3. Determine what portion of the procedure you are responsible for. For instance, if you have a deductible of $100 and have already paid $50 for the year, you still have to pay $50 toward the deductible. If your coverage after that is 80%, then you are responsible for the other 20%. So you will pay $50+20% of the cost of your procedure if it is covered.

Making Quality Dental Care Accessible

If all of this sounds confusing, you are not alone. Many people are frustrated by the many restrictions of both HMO and PPO dental insurance plans. At Wright County Family Dental, we offer alternatives that save you money without the confusion. Our in-house dental savings plans for uninsured patients have no deductibles, surprise fees, or waiting periods, so you can begin using them immediately for excellent preventive care and savings on all other dental procedures without limitations.

Have Questions About Your Coverage? We’re Here to Help

Our knowledgeable staff can help you navigate your dental insurance to maximize your benefits. If you have any questions or would like to sign up for one of our Dental Membership Plans, please give us a call at Clarion Office Phone Number 515-532-2529 to get started.