Facts You Need to Know about Dental Insurance

Did you know that nearly two in five Americans claim to have limited or delayed their dental care due to their financial situation? This same study found that more than half of the survey respondents consider routine dental visits a “nice to have” appointment that can be delayed. It seems that many people avoid the dentist due to the pain their wallet might feel, rather than fear of tooth pain. 

Avoiding regular dental check-ups or delaying help for any dental issues you may be experiencing will end up costing you more money in the long run. Another surprising finding of this study showed that 80% of the survey participants would still decide to postpone their routine visits, even knowing there will be long-term financial implications. At Simply Smiles, we want to empower you to take control of your oral health and know you do have choices! There is another way. 

We encourage you to take advantage of your dental insurance! Most companies provide dental insurance for a minimal fee that comes out of each of your paychecks. If your company doesn’t provide dental insurance, you can purchase your own private insurance in the range of $29-$69 per month, depending on what plan you choose – this is a fraction of the monthly cost for regular health insurance. You’ll need to pay attention to what insurances your dentist accepts. Click here for the list of insurances we accept at Simply Smiles. 

Every insurance plan is different, so it’s important to do your research to find the plan that best fits your needs. Here are some facts to keep in mind when looking for a dental insurance plan: 

  • Most dental plans work on a 100-80-50 percentage model.
    • This refers to what percentage the insurance company will pay for which procedures. Most dental plans will pay 100% for preventive care – exams, X-rays and cleanings. Then 80% for basic procedures like fillings, root canals, or extractions. Finally, they will usually pay only 50% of major procedures such as crowns, bridges, implants, and gum-disease treatment.
  • HMO vs. PPO plans
    • HMO and PPO plans are the two most common types of affordable plans available. Preferred Provider Organization (PPO) plans usually come with deductibles, benefits maximums, and percentage costs outside of preventative services, but you’ll have a larger pool of dentists to choose from. Health Maintenance Organization plans (HMO) plans typically have lower premiums, no deductibles or max benefits, and fixed co-payments for treatments, but your choices for dentists will be significantly smaller than with a PPO. 
  • Use your deductible and yearly coverage maximums to your advantage. 
    • Deductibles are a certain amount you have to pay for services (other than preventative care) before insurance will kick in – usually around $50-$100. Dental plans also have a max annual limit of how much the insurance company will pay for treatments until you have to pay – usually around $2,000 for good plans. Work with your dentist to schedule you or your child’s dental treatments in order to get the most out of your plan. Whether by getting all your work done in a year, or spreading the procedures out between two years in December and January, there are ways to make your plan work for you. Just remember, benefits don’t roll over from year to year, so use them or lose them! We have another post about this here
  • Go to a dentist that is in-network with your insurance. 
    • Check your insurance’s website for a list of dentists who are in-network with their plans. If you go to an out-of-network dentist, you’ll be paying more for their service, if your insurance company even covers any of it at all. 
  • Insurance typically will not cover cosmetic procedures. 
    • It’s important to keep in mind that most insurance companies don’t cover dental work that is not considered essential. Cosmetic procedures and most Orthodontia work will not be covered under insurance, so it’s best to check with your insurance provider before getting this work done. 

If you are not able to get on an insurance plan, don’t fear! At Simply Smiles Miami, we offer a membership plan as a cost-effective way for you to get exclusive discounts on our services like annual exams, cleanings, and more! We understand insurance can be tricky and dental costs can be scary, which is why we are up-front with our clients about costs and treatment plans to make sure you are comfortable before we move forward with any procedures. Call our office today and we’d love to help you navigate your financial options so we can make sure your smile is a top priority in your life!


 Sources: 

https://www.investopedia.com/articles/personal-finance/111715/how-does-dental-insurance-work.asp

https://www.wecaredentalcare.com/post/11-helpful-tips-to-get-the-most-out-of-your-dental-insurance

https://www.mthollyfamilydentistry.com/blog/maximize-dental-insurance-benefits/

https://www.kqed.org/stateofhealth/82806/5-steps-to-getting-the-most-out-of-your-dental-plan-insurance-ask-emily

https://theperfectsmilekc.com/10-dental-insurance-facts-to-help-you-get-the-most-out-of-your-dental-insurance-plans/

https://www.investopedia.com/articles/personal-finance/120914/4-important-steps-choosing-dental-insurance.asp

https://www.fidleronthetooth.com/blog/dental-insurance-assurance-questions-answered/

http://odd.doq.mybluehost.me/new-patients/

https://www.dentalproductsreport.com/view/americans-limit-or-delay-dental-care-due-financial-concerns-survey-finds

https://www.deltadentalwa.com/dental-insurance-101/how-much-does-dental-insurance-cost




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