Dental Insurance Guide: Types, Coverage, Benefits

Types of Dental Insurance Plans

There are several types of dental insurance policies available to consumers. It’s important to evaluate your individual needs and budget to find the best dental insurance coverage for you. Here are the most common dental insurance plans.

Dental PPOs

A preferred provider organization (PPO) dental plan allows patients to receive care from any provider they want. It is a popular option for people who want the flexibility to work with a dentist of their choice without waiting for referrals, or being limited to a smaller network. However, this flexibility comes with the potential for higher premiums.

While you can choose your dentist, the cost savings potential of PPO dental insurance is best when you select a provider that is within the PPO network. Insurance companies negotiate lower rates with these providers, passing on the discounts to patients. You will also get the full extent of your insurance benefits with an in-network dentist.

Dental HMOs

Dental health maintenance organizations (DHMOs) are another popular type of insurance plan. DHMOs typically have a lower premium and out-of-pocket cost than dental PPOs, helping patients to keep costs manageable.

However, you can only work with dentists within the HMO network to take advantage of your insurance benefits. You will also need a referral from your primary care dentist to see a dental specialist.

Dental EPOs

An exclusive provider organization (EPO) dental plan is a less common option than PPO and DHMO plans. It combines certain features found in PPO and DHMO plans, giving patients both flexibility and cost savings.

A dental EPO plan is like a DHMO in that you must choose from a network of dental care providers to use your insurance benefits. If you see a dentist outside of the network, you must pay for the services on your own. However, the network is much larger than a typical DHMO, allowing patients more flexibility and access to a wider range of providers — much like a PPO.

Indemnity Plans

An indemnity dental plan is a fee-for-service plan often called “traditional” insurance. While you can choose any dentist without worrying about restrictive networks, you must pay for services out of pocket before being reimbursed. After paying, you file a claim with your insurance to compensate you for a portion of the expense.

This option can be more pricey if you see your dentist often because you do not have access to negotiated lower rates. The amount reimbursed to you is based on usual, customary, and reasonable (UCR) fees, so different treatments are not always fully covered.

Discount Dental Plans

Although discount dental plans are not true dental insurance, they help patients afford the care they need at reduced rates. For example, you may pay an annual membership fee to join a discount dental plan, and get access to exclusive discounts offered through that plan.

While you pay out of pocket for dental services, the rates are significantly lower than what you would pay without the membership. Also, you must find a local dentist who accepts the dental plan, and has availability to take advantage of the savings.

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Key Features of Dental Insurance

When you understand the terms and features in your policy, you can maximize your dental insurance benefits. Key features to keep in mind include the following:

Insurance Premium

A dental insurance premium is the regular payment you make to the insurance company to receive coverage. In other words, your premium is the cost of dental insurance. It can be paid monthly, quarterly, or annually. If you have dental insurance through your employer, a certain amount may be deducted from every paycheck to cover your insurance premium.

Deductible

An insurance deductible is the amount you must pay out of pocket before your insurance plan begins to cover services. This is a fixed amount that is established in your policy. After meeting your deductible, your insurance plan will begin to cover costs.

Co-Pay

A co-payment or “co-pay” is a flat fee you must pay upfront for a dental service or treatment. You pay the provider directly before receiving care. However, not all services require co-payments, and co-pays may vary for different types of dental treatments.

Coverage Levels

How much your insurance plan covers for services will depend on how it is categorized. Dental insurance typically covers a different percentage for preventive care, basic services, major services, and other types of care. Refer to your policy to understand these differences, and avoid unexpected costs.

Waiting Periods

Some insurance plans have waiting periods between the time you enroll and when coverage actually starts. During the waiting period, you cannot file claims or access your benefits. While this is common for major dental work, you will likely have immediate coverage for preventive services.

Annual Maximums

The annual maximum refers to the amount your insurance plan will cover in a benefit period. It is the limit your policy will pay out for the year. Depending on your plan, certain services and preventive care may not count toward your annual maximum, which resets at the beginning of another period.

Understanding Dental Insurance Coverage

Different dental insurance plans provide varying levels of coverage that will help you keep your mouth healthy while minimizing costs. Check your policy to see if you are fully or partially covered for these services.

Preventive Care

Almost all dental insurance plans cover preventive dental care, including:

• Dental exams
• X-rays
• Teeth cleanings
• Fluoride treatments
• Dental sealants

Basic Services

Basic dental services include standard restorative procedures that treat issues in their early stages, and prevent them from worsening. Your dental plan will likely cover a higher percentage of cost for these common basic services:

• Diagnostic X-rays
• Teeth fillings
• Simple tooth extractions
• Root planing

Major Services

Major dental services are more complex procedures, treating issues that could have been caught and corrected with earlier preventive care or basic dental services. These services are more costly, and your insurance plan may not cover as much. Common major services include:

• Dental crowns
• Dental bridges
• Root canals
• Dentures
• Oral surgery

Orthodontics

Not all dental insurance plans will offer coverage for orthodontics. However, some PPO plans and discount dental plans can help make orthodontic treatment more affordable. You can also look into separate policies that are specifically for orthodontic care. Check your policy for benefits that may cover:

• Metal braces
• Ceramic braces
• Clear aligners
• Invisalign

Cosmetic Procedures

Dental insurance mainly covers medically necessary procedures that help you maintain good oral health. Because cosmetic procedures focus on the aesthetic appearance of your smile, they are generally not covered by insurance. Ask your dentist about discounts, special offers, and payment options for:

• Teeth whitening
• Porcelain veneers
• Dental bonding
• Braces

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How To Choose the Right Dental Insurance Plan

Whether you’re looking for the best dental insurance plans for families in Las Vegas, or full coverage dental insurance that will help you afford major services, it’s essential to do your research.

• Evaluate personal needs: Review how frequently you visit your dentist, how many people in your family will be on the policy, and if you require specific treatments.
• Costs and affordability: Look at insurance premiums, deductibles, and in-network dentists to see what option is most cost-effective for your needs.
• Understand coverage exclusions: Review what types of services are not covered under the policy to avoid unexpected costs, and the inability to receive the care you need.
• Review customer support and flexibility: It’s important to find an insurance provider that is easy to contact, responsive, and offers online tools to help you understand your benefits.

After considering these factors, you will have a clearer idea of what dental plan is best for you and your family.

Regulations and Consumer Protections

As an American consumer, you have rights that protect you from insurance fraud, unfair treatment, and blocked access to quality dental care. Nevada law requires that the Commissioner approves and regulates dental insurance plans and fully discloses:

• Significant exceptions
• Reductions or limitations that apply to the plan
• Any other information that provides full and fair disclosure of the plan

The National Association of Insurance Commissioners (NAIC) also protects consumers by establishing standards that ensure a fair, competitive, and healthy insurance market. If you experience a problem with your insurance company, you can file a complaint with the NAIC.

Maximize Your Insurance Benefits at Absolute Dental

At Absolute Dental, we are committed to providing the highest quality care that is affordable and accessible for Nevada communities. We accept most dental insurance plans, and offer special discounts through our Smile Saver dental plan.

Explore plans with local insurance providers or your employer to find the right one for you. Then, contact our team to see how you can maximize your benefits at one of our offices. We are ready to partner with you and your family on all your dental care needs.

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Neighborhoods We Serve in Las Vegas 

At Absolute Dental, we’re proud to provide comprehensive dental care to families across Las Vegas. Whether you’re in need of teeth cleaning, cosmetic dentistry, braces, or pediatric dental care, we’ve got you covered. From general care to emergency dental services, we’re here to help you and your loved ones maintain healthy, beautiful smiles, with convenient locations in your neighborhood. 

Our Neighborhood Locations: