Dental implants are an excellent option for replacing missing teeth. They are long-lasting and look and function just like a natural tooth. However, it is important to check your dental insurance to see if they cover implant treatment.
Different plans have varying coverage amounts, deductibles, and annual maximums. Some have waiting periods while others don’t.
1. Look for a Preferred Provider Organization (PPO):
Dental implants can provide a permanent solution for missing teeth. However, they can also be quite expensive. Fortunately, dental insurance for implants can help reduce these costs. When shopping for a policy, pay attention to premiums, deductibles, waiting periods, and annual maximums.
The deductible is the amount you will need to spend on your dental care before your insurance starts paying. Most plans have a deductible, while some DHMO plans do not. You should also look at coinsurance, which is the percentage of costs that you and your plan share after the deductible has been met. Some plans also have an annual maximum, which means that after a certain dollar amount has been spent in a year, the remaining expenses will be your responsibility.
2. Check for Dual Coverage:
Dental implant coverage is available through a variety of dental insurance providers. Regardless of which plan you have, it’s important to stay within annual maximums and utilize in-network professionals for the best results.
Many people have more than one dental insurance plan; this is called dual coverage. Generally, dental plans work together to coordinate benefits. For example, if your primary plan allows 80 percent coverage for dental cleanings and your secondary plan pays at an 80 percent rate, then the secondary plan will not pay any additional amount beyond what the primary plan covers.
This coordination of benefits helps to limit out-of-pocket expenses for those with more than one insurance policy. Your dentist and your insurance company must know about your dual coverage status to ensure your claims are processed correctly.
3. Check for Exclusions and Limitations:
Dental insurance plans often include annual coverage maximums and exclusions. By understanding these policies, patients can make better treatment decisions. In addition, they can avoid any pitfalls related to the limitations of their plan and minimize unexpected expenses.
For example, some plans may exclude certain procedures, such as root canals or tooth implants. Others may have frequency limitations, which limit how many times a particular service can be performed in a given period. Additionally, some plans may have total lifetime limits that affect all services throughout a patient’s life. Other restrictions may include deductibles, copayments, and waiting periods. These limits can significantly increase your costs.
4. Check for Out-of-Network Dentists:
Many dental insurance companies have a list of in-network providers with whom they have a contract to offer services at specific rates. When patients choose out-of-network providers, they usually pay more for the services. This can add up quickly, especially if you exceed your annual maximum.
Dentists who choose to be out of network with insurance companies can give notice and not take new patients covered by that plan. This allows them to be free of the limitations that insurance companies place on in-network dentists and focus on what is best for their patients. This can save you both time and money.
5. Check for Waiting Periods:
Many dental insurance providers have waiting periods in place to help them forecast costs and prevent people from buying a plan, using it for expensive treatments, and then canceling it as soon as their treatment is over. This can be a good thing for patients, but not so much for dentists, who may not be paid for procedures they perform until the waiting period expires.
If you have an employer-sponsored plan, review your options to see if there are any plans without waiting periods. You can also check with your state’s insurance marketplace to find individual plans that offer coverage without a waiting period. Alternatively, you can consider purchasing a direct reimbursement program that offers dental care at a discounted rate and doesn’t have deductibles or annual maximums.
6. Check for Direct Reimbursement Programs:
Depending on the type of plan you choose, you may need to pay a copay or deductible. A copay is a fixed dollar amount that you must pay for each visit or treatment. A coinsurance is a percentage of the cost of a covered procedure that you must pay after you meet your deductible.
Most dental insurance policies have an annual maximum, which is the limit on how much the policy will pay toward your care within a year. Some also have a lifetime maximum for specific services, such as dental implants.
A high annual maximum and low implant cap will help make it more affordable to get the dental care you need.
7. Check for Deductibles and Copays:
Once people determine their dental needs, budget, and anticipated level of care, they can start looking at individual plans. Each plan has a different annual maximum (the maximum amount the insurance company will pay towards a procedure within a benefit period, usually a year) and coinsurance/copayments.
Typically, each family member has their own individual deductible, but as they pay them off, they feed into the family deductible. Some plans also exclude preventive services from the deductible, but others will cover them 100% or at a lower copayment. This is something to check carefully.
8. Check for Annual Maximums:
Unlike medical insurance, which typically has a maximum out-of-pocket amount, dental plans often have annual maximums that limit the total your plan will pay within a specific benefit period (e.g., a year). While many dental plans do not count standard preventive and diagnostic procedures toward the annual maximum, it’s important to check your policy details because annual maximums can vary widely.
When you reach your annual maximum, your insurance company will no longer cover any of your treatment costs until the next benefit period begins. Therefore, it’s a good idea to choose a dental plan with a high annual maximum. This is especially true if you are considering dental implants.
