How Does Dental Insurance Work In 2024? (Ultimate Guide)

Dental insurance works almost like health insurance. You pay a premium every month, and it renews every year, but there is a maximum limit on what dental insurance covers during the year. If you meet that threshold, and then you have any other dental work done, you will have out-of-pocket costs.

How does dental insurance with a maximum limit work?

Most dental insurers have a limit set at a maximum for the calendar year. This is usually around $1,000 to $3,000, depending on the insurance company. As stated earlier, after the maximum is hit, you will have out-of-pocket costs to deal with. There is also the point that if you do not use all of it, it does not roll over to the next year. However, there is supplement dental insurance’s out there that has no limits, but it is expensive to have.

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How long does it take for dental insurance to work?

Many insurance companies have a set time limit before you can use the plan you have. Most basic procedures have to wait up to six months before being covered, but with major procedures, it could take a year or longer. It all depends on the insurance you have. There will be a chart later on with the wait times of the companies and other information you might be interested in.

What is basic dental care?

Basic dental care will depend on the policy and the company you are using.

Could be considered basic dental care:

Fillings
Emergency care for pain
Routine extraction
Root Canal (could be considered major)
Non-routine x-rays

What is major dental care?

Like with basic dental care, major dental care will depend on the policy and the company you are using.

Could be considered major dental care:

Dental crowns (could be considered basic)
Bridge work
Braces
Wisdom teeth
Complex extractions
Tooth implants
Dentures and denture repair

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What does dental insurance typically cover?

What dental insurance covers depends on the insurance policy and company, as they all differ from each other. They go from preventive care to basic procedures to major procedures. Usually, dental insurance policies go by the 100-80-50 rule in what they cover. Which means 100%, 80%, and 50% each for preventive, basic, and major in the exact order. The basic and major procedures are not one hundred percent covered, so you have the responsibility of paying for the half that is not covered.

They will not cover anything after you hit the maximum for the year. Anything after that, you are paying for it, and if you have a lot of basic work done, it can add up quickly and push you over the limit that your policy is set at.

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How do dental claims work?

The patient must be seen and receive care, then the dental office sends the bill to the insurance company.
The insurance company has a claims processor who makes sure the claim is accurate and if it will be covered or not.
The insurance company then pays the amount depending on the service rendered.
That amount will then be applied to the policy after it is approved.
If there is a remainder, it will be noted on the bill that is sent out.
The patient would make sure everything was accurate, and then if they owed they would pay the amount due.

How do you make a dental claim?

Either you or your dentist will make the dental claim. For most, though, they will do so themselves unless you visit a different dentist while travelling. If you do that, you will be the one filling out the claim with your insurance.

Here are the things you would need to file a claim:

The claim form from your insurance company.
Your information.
Dentist’s name, address, and phone number.
The date of the procedure(s).
Description of the procedure and how much it cost.
The list of the affected area(s) of the mouth.
The total cost.
The dentist’s national provider information (NPI)
The dentist’s tax identification number (TIN)
State license number.
The specialty codes.

Make copies for your records just in case anything gets lost. Mail the original copy to the address on the claim form.

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Do dentists guarantee their work?

They can offer warranties on their work. They are advised against making lifetime warranties due to the multiple interpretations that could be made. So, the warranties will be limited for a few years after the original procedure is done. They cannot fully guarantee their work for a long time due to the changes that could happen within your mouth or your activities that could hinder their work.

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A list of the average cost of procedures

Name of Procedure	Average Cost
Regular exams and cleanings	$75-$200
Wisdom Teeth removal	$75-$250 per tooth, $200-$600 impacted tooth, $600-$1100 for all four, $600-$1100 for anesthesia, and one wisdom tooth removed.
Bridges	$1,000-$5,000
Crowns	$1,100-$1,500
Dentures	$1,000-$15,000 per arch.
Tooth Extractions	$75-$200 per tooth and $800-$4,000 for impacted teeth.
Fillings	$50-$150
Root Canals	$600-$1,500
Braces	$3,000-$13,000

Please remember that all these prices are just ranges and are not the exact prices. The price of each procedure depends on the dentist and the oral surgeon that you use and what all you have done in the procedure. It also depends on how much your insurance covers.

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What is the difference between HMO and PPO dental insurance?

HMO dental insurance

HMO is Health Maintenance Organization. You are restricted to the primary dentist you choose unless it is an emergency or referred to another dentist. This type of plan limits you to being stuck with just one dentist instead of being able to go to other places to get work done. With HMO’s, you do not have a deductible most of the time.

PPO dental insurance

PPO is Preferred Provider Organization. With this plan, you are not restricted like you are in an HMO plan. You can have a primary dentist, go to other dentists, and use the benefits even if they are outside of your network. You will have to pay a copay with a PPO plan.

Whichever one you decide to get, make sure that it will work for your needs and what you can afford. Unexpected situations do happen, and they are a part of life. Do your best to try and plan for what could take place when choosing the insurance policy you are going to go with.

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Insurance companies and their information

Insurance Company	Waiting period	Deductible	HMO or PPO
Delta Dental	0 for basic 6,12, 24 months for major procedures	$ 50 for individual and $50 each family member.	Both
Humana Dental	Depends on the plan, but most have no waiting period, except for one, and it is a 6-month waiting period.	$50 for individual and $150 per family.	Both
Cigna Dental	Depending on the plan, you could have a waiting period of six months to a year, depending on the plan you choose.	$19 to $40 per month depending on the plan.	Both
MetLife Dental	No waiting period for major procedures.	$50	Both
Costco Dental	No waiting periods.	No annual deductible. Other dental expenses may apply.	HMO

Note that what is in the chart above is liable to change over time and depends on the plan that you get. Most of the deductibles do stay the same in the plans, but always be sure of what your plan entails.

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Why you should check with the Better Business Bureau before getting insured with a company.

People go to the BBB to give reviews and complaints about companies. This makes it a good place to go when deciding on dental insurance. Especially if you have no dealings with any of the dental insurance that you have found. You may find that the company is not very good at handling what your needs are. You could also find out that the company barely covers what they say they will and leaves people to pay for the procedures that should be covered by the insurance.

This would help you not fall victim to fraudulent companies and also scams that some people use. It will save you a lot of financial stress if you are well informed about the company and its practices. That way you will not make quick decisions on the insurance that you need.

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What are the implications if you do not have dental insurance?

There are a lot of things that could happen to your teeth, and if you do not have dental insurance, it could spell trouble in more ways than one. You would have to pay the full amount out of pocket. You risk getting bad teeth and infections if you do not have regular checkups. The possible infection could lead to sepsis, which would lead to a hospital bill or death.

This is the reality for most people in the US, as not a lot of people can afford dental insurance due to their circumstances.