DENT-INS

DENTAL INSURANCE

®

DENTAL INSURANCE

Dental insurance makes dental care more affordable. With a focus on prevention, dental insurance typically covers professional services like routine check-ups that enable your dentist to detect problems early on and help you avoid future costly and complex procedures. Dental insurance may help lower costs by covering a significant portion of preventive care (exams, cleanings, sealants, etc.) and some portion of more extensive procedures (fillings, crowns, extractions, space maintainers, etc.).

Dental terms to be familiar with:

• Premium: the amount you pay for dental benefits. • Deductible or out-of-pocket costs: the amount you pay towards covered services before insurance benefits are paid. • Coinsurance: the amount that you pay for a covered dental treatment (usually a per centage) after paying your deductible. • Copay: the fixed dollar amount you pay for a service covered under your dental plan. Deductibles, Coinsurance, and Copayments are set by your insurance company. It is the duty of the healthcare provider to collect payments and the responsibility of the insured to be knowledgeable of their plan benefits and possible out of pocket expenses.

Dental insurance is the best way to be prepared for any unexpected dental problem that might arise, and it will help identify problems at an earlier stage during regular check-ups at no or low cost. Whether selecting dental insurance through your employer or on your own, follow this step-by-step guide. 1. Evaluate Your Needs If you have children, preventive dental care is important. Make a list of your family’s dental needs - both past, present, and predicted future. Calculate how much you have paid in the past year for dental care visits. This information will serve as a benchmark. How to choose a dental insurance plan

2. Understand Dental Insurance Plans Preferred Provider Organizations (PPO) Plans: PPO Plans typically allow you to receive care from any dentist, but coverage may differ from in-network and out-of-network dentists. Dental Health Maintenance Organization (DHMO) Plan: DHMO Plans typically require you to receive care from an in-network dentist if you want to use your insurance coverage. Discount Plans: you choose from a panel of participating dentists who charge discounted fees for their services. You pay these fees directly to the dentist at the time of treatment; no contract is necessary. Discount plans typically have lower premiums than PPO and Managed Fee for Service Plans. Fee-for-Service Plans: also known as Indemnity or Traditional Plans, offer the largest network of providers. Similar to a PPO plan, you pay a percentage for each service provided by an in-network dentist and the plan covers the remainder.

3. Evaluate Your Options Creating a list of pros and cons can help guide you through the decision-making process. Consider the following questions: • What is the annual maximum limit? • Is there a waiting period? amount of time you must wait to be able to access your benefits. • What are the differences between in-network and out-of-network dental visits in terms of coverage? • At what age does the plan define a child (usually 12-14 years) versus an adult? Once your child exceeds that age, insurance coverage and specialist care may change. 4. Determine Which Plans are Available in Your Area You may not have access to all types of dental insurance plans listed above, the plans you can choose from will depend on what is available in your area. 3. Evaluate Your Options Creating a list of pros and cons can help guide you through the decision-making process. Consider the following questions: • What is the annual maximum limit? • Is there a waiting period? amount of time you must wait to be able to access your benefits. • What are the differences between in-network and out-of-network dental visits in terms of coverage? • At what age does the plan define a child (usually 12-14 years) versus an adult? Once your child exceeds that age, insurance coverage and specialist care may change. 4. Determine Which Plans are Available in Your Area You may not have access to all types of dental insurance plans listed above, the plans you can choose from will depend on what is available in your area.

Make sure to consider: • Premiums (amount and frequency) • Co-payments • Deductible • Annual maximum

This will help you understand your options from a financial perspective and make the choice that best aligns with your family’s budget. Do not rush into the decision, take time to evaluate your dental needs, budget, and anticipated level of care.

American Academy of Pediatric Dentistry 211 East Chicago Avenue, Suite 1600 Chicago, Illinois 60611 (312) 337-2169 aapdinfo@aapd.org www.aapd.org; www.mychildrensteeth.org ©2022 American Academy of Pediatric Dentistry. All rights reserved.