Dental Insurance Explained Like You Are Five

Overview

There are three types of dental insurances:

• Medicaid/Medicare
• HMO
• PPO

This article focuses on PPO insurance. PPO Insurance allows you to see any dentist of your choosing. PPO Dental Insurance in Orland Park, IL typically costs:

• $30-$50 monthly
• $360-$600 yearly

Your insurance plan will typically have a "maximum benefit" of $1,500. This means that the insurance will pay up to $1,500 per year for your dental procedures. After your insurance pays out $1,500 on your behalf, all further expenses will have to be paid by you until your insurance renews.

Deductible

A deductible is the amount that you have to pay before your insurance will start paying money on your behalf. A deductible is typically $50-$100. Once you pay this deductible, your insurance will pay up to the maximum benefit (typically $1,500) for your dental procedures.

Three Dental Categories

There are three dental categories to be aware of:

1. Preventative
2. Restorative
3. Major

Most insurances will pay:

• 100% for preventative procedures
• 80% for restorative procedures
• 50% for major procedures

The remaining percentage that insurance does not pay for has to be paid by you. Therefore, you will typically have to pay:

• 20% of the restorative procedures cost yourself
• 50% of the major procedure costs yourself

Cosmetic Category

There is also a fourth category called Cosmetic that dental insurances will cover 0% of. This is because cosmetic dental work isn't required to keep one's teeth healthy but rather something patients may elect to get to further enhance their teeth. These include procedures such as:

• Teeth whitening
• Dental bonding
• Invisalign braces

Example

Please note that this is just an example based on what we typically see but each individual plan is different.

Let's say your dental insurance has:

• Maximum benefit of $1,500
• Deductible of $50

You go in for a semi-annual check up which includes an exam, x-rays, and a simple cleaning. The diagnosis is that you will require a filling on one of your teeth for a cavity they found. Therefore, four procedures were done:

• Exam (preventative)
• X-rays (preventative)
• Simple cleaning (preventative)
• Cavity filling (restorative)

Cost Breakdown

| Procedure | Insurance Pays | Total Cost | Insurance Portion | Patient Portion | | --------- | -------------- | ---------- | ----------------- | --------------- | | Exam | 100% | $50 | $0 | $50 | | X-Rays | 100% | $100 | $100 | $0 | | Cleaning | 100% | $100 | $100 | $0 | | Cavity | 80% | $150 | $120 | $30 |

In this example, although insurance covers 100% of your Exam, insurance will only start paying after you pay your deductible. Therefore, after you pay your $50 deductible, insurance will start paying for your further treatments such as X-Rays and Cleanings.

Insurance has paid out $320 on your behalf in this example. Therefore, out of the maximum benefit of $1,500, you still have $1,180 remaining for other procedures that you want to get done.

Which Dental Insurance to Choose

Choosing a dental insurance plan can be overwhelming. It is important to look at:

1. Monthly payment amounts
2. Maximum benefit
3. Coverage percentages for the three main categories

What is Dental Insurance?

Think of dental insurance like a piggy bank that helps you pay for your teeth doctor (dentist). You put a little money in each month, and when you need to see the dentist, the piggy bank helps pay for it!

How Does It Work?

The Monthly Payment (Premium)

Just like you might get a weekly allowance, you (or often your mom and dad's work) pay a small amount of money each month to keep your dental insurance. This is called a "premium."

The Yearly Piggy Bank (Annual Maximum)

Each year, your dental insurance piggy bank has a certain amount of money it can spend on your teeth. This is usually around $1,000 to $2,000. Once you use all this money, you (or your parents) need to pay for dental visits yourself until next year.

The Small Fee (Copay)

When you visit the dentist, you might need to pay a small amount yourself - like paying $5 from your own allowance. This is called a "copay."

What Does Dental Insurance Cover?

Dental insurance usually pays for different things in different ways. Let's break it down like a sandwich:

The Free Stuff (Preventive Care) - 100% Coverage

• Regular checkups (like counting your teeth!)
• Cleaning your teeth
• X-rays (special pictures of your teeth)

The Partly Covered Stuff (Basic Services) - 80% Coverage

• Fixing cavities (tooth holes)
• Pulling out very loose teeth
• Treating sore gums

The Expensive Stuff (Major Services) - 50% Coverage

• Crowns (like tiny hats for your teeth)
• Bridges (fake teeth that stay in place)
• Root canals (fixing very sick teeth)

Waiting Periods

Sometimes, when you get new dental insurance, you have to wait a little while before you can use it for certain things. It's like when you get a new video game, but you have to complete level 1 before you can play level 2.

In-Network vs. Out-of-Network

In-Network Dentists

These are like your dental insurance's best friends. They've agreed to charge special prices, which means you pay less!

Out-of-Network Dentists

These dentists haven't made special agreements with your insurance. Going to them might cost more money - like buying candy at the movie theater instead of the grocery store.

Tips for Using Your Dental Insurance

1. Always go to your regular checkups - they're usually free!
2. Ask your dentist about prices before getting work done
3. Keep track of how much money is left in your yearly maximum
4. Try to use in-network dentists when you can

Conclusion

Dental insurance helps keep your smile bright and your wallet happy! Remember:

• Pay a little each month
• Get free checkups
• Pay small copays for visits
• Stay within your yearly maximum
• Use in-network dentists when possible

Now you know the basics of dental insurance - it's not so complicated after all! Just remember to brush and floss, and your dental insurance won't have to work as hard.