insurance paperwork being handed to a client

Insurance is not always intuitive. Sometimes you need help grasping the details, terms used, and frankly, your dental plan as a whole. Naturally, it can take some time to familiarize yourself with everything.

In this blog, we’ll be breaking down the concept of dental insurance and teaching you the basics of what you need to know. Should you have any further questions, we will do our best to help.

What is Dental Insurance?

Dental insurance is a form of health insurance built to cover a portion of the costs associated with dental care. There are many providers of dental insurance and all differ in the types of services that they will cover and how much it costs to purchase a plan.

Many employers offer dental insurance benefits for their employees. There are often options for individuals, families, and groups. When you’re new to the insurance realm, all of the jargon used can be confusing. Let’s go over a few very common terms real quick.

Some common terms to look out for are:

  • Annual Maximum: The total amount your dental plan will pay during a year. Maximums are determined by either your employer or the dental plan as a whole. You pay copays and any amount that goes over the annual maximum.
  • Deductible: The amount of money you pay out of pocket before a benefit plan will pay for a service. If your deductible is $60 and you’ve paid that much already, your plan will then begin to take effect.
  • Waiting Period: The maximum amount of time you need to wait until you’re covered for dental care outside of preventive exams.
  • Premium: How much you’re required to pay your benefits provider for dental coverage, typically on a monthly basis. A portion of this cost may be covered by your employer.
  • Frequency Limit: The maximum number of times a particular service is covered within a benefit year.

How is it Different from Medical Insurance?

They are both insurance so they have to be the same, right? Not quite. For one, dental insurance focuses solely on the mouth while medical insurance largely involves the rest of your body.

Dental insurance is also more geared toward preventive care. Not that medical insurance isn’t, but that type of insurance has to instead consider unpredictable illnesses that likely cost a person greatly.

An unwanted dental issue, in comparison, does not cost as much for an insurance company. Problems are also often prevented with regular cleanings or at-home care. Dental plans also pay for care based on the type of service you receive (preventive, restorative, orthodontia, etc.).

Limitations and Exclusions

With most dental insurance plans, it is common for certain services to be excluded from coverage. This typically includes procedures related to orthodontics or ‘non-essential’ cosmetic dentistry. Experimental procedures and some pre-existing conditions also factor into what gets excluded by your particular plan.

Most plans also have a “cap” on what the insurance company is willing to pay for the given year. For some individuals, this cap is often low but for others, it suffices. This cap is also known as the annual maximum and any expense that goes beyond it, you pay.

Limitations within your plan depend on time or the frequency of services received. They determine how often a service receives coverage. For example, most insurance plans only allow for two cleanings a year or one every six months.

Particular forms of treatment tend to get excluded in order to keep costs lower.  Before pursuing certain procedures, confirm all that earns coverage and what does not.

Affordable Alternative to Dental Insurance

If for any reason you do not have your own dental insurance or you’re looking for other options, we’ve got you covered. Our dental membership plan provides a more accessible alternative to traditional insurance and here’s why:

  • No pesky waiting periods after receiving care.
  • Ability to save money on ALL in-house services.
  • No service exclusions
  • No annual limit or maximum on savings.
  • No paying for services you don’t use.

This is a great option for individuals who are without insurance, losing coverage, unhappy with current plans, retired, looking to save, and small businesses. Our dental staff is more than happy to provide additional information. Above all else, we want to help you choose what is best for you and your family.

We Can Help Answer Your Insurance Questions

Trying to navigate dental insurance can feel overwhelming at times. Don’t stress, our dentists in Grand Rapids and Grand Haven, MI, and entire dental staff are here to help you get the care you need. Make an appointment today by calling one of our MI Smiles Dental locations or contact us online.