Professional oral health services are essential to maintaining a healthy, beautiful, and functional smile, and dental insurance can significantly reduce the associated costs. While the staff at your dentist’s office will be happy to help you understand your insurance policy when they see you for your consultation, this guide can help you develop a better idea of how your plan works until then. Here’s a quick look at how most dental insurance policies work.
How Are HMOs and PPOs Different?
An HMO policyholder will probably be required to see a dentist who is in network with their insurance plan to qualify for any coverage, but the policy probably won’t impose many restrictions other than that. While a PPO policyholder can usually see any dentist they like and still qualify for coverage, their plan may impose limitations such as:
- A waiting period: Some insurance policies will only come into effect several weeks or months after being signed.
- A deductible: This means that the patient must pay a certain amount of money for treatment in a year before the plan will start paying for anything.
- An annual maximum: This defines how much money an insurance policy can pay in a year.
How Does PPO Coverage Work?
PPO dental insurance plans are typically designed to encourage policyholders to seek regular preventive care that can make costly restorative treatments unnecessary, which helps keep patients healthy and rates low for everyone. Accordingly, they typically offer coverage that works something like this:
- 100% coverage for routine care like checkups, cleanings, and X-rays. This may also include at least one emergency dental visit per year.
- About 80% coverage for minor restorative work like fillings and gum disease treatment.
- About 50% coverage for major restorative work like extractions, dentures, and bridges.
- No coverage for medically unnecessary elective procedures like most cosmetic work.
One of the best ways to get the most out of your dental insurance policy is to schedule routine checkups at your dentist’s office every six months. This will allow your oral health provider to consistently monitor your dental health, address problems in their early stages, and recommend better hygiene habits. These appointments can help you avoid painful oral infections and maintain a beautiful smile you’ll be happy to show off.
About the Author
Dr. Sean M. Altenbach earned his dental degree at the University of Florida and is certified by the Dental Organization for Conscious Sedation. He is also a proud member of the American Dental Association, the Florida Dental Association, and the Guild of Dental Scholars. His office in Jacksonville offers general, restorative, cosmetic, and emergency dentistry. To schedule your next checkup, contact his practice online or dial (904) 448-0441.