Family dental insurance is for people who want to make room in their budget to protect their family’s healthy smiles. More straightforward than health insurance, family dental insurance policies include simple details about what procedures are covered and exactly how much you must pay out-of-pocket. At Shelton Insurance, we’re happy to sit down with you and explain all the benefits available to create your perfect family dental insurance plan.
Family dental insurance is available as part of medical insurance plans or as a standalone policy. You can visit any licensed dentist, but you’ll usually save the most when you visit a dentist in your plan’s network.
Family health insurance is very important, but many people have trouble understanding which health plans to purchase, what benefits they’re getting, and how much they need to pay at certain times. That’s where we come in. At Shelton Insurance, we choose family health insurance plans that are tailored to your family’s needs, so you can be confident you’re covered when it counts. You never know when you’ll need medical help.
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Family dental procedures covered by insurance policies are typically grouped into three categories of coverage: preventive, basic and major. Most dental plans cover 100% of preventive care such as annual or semi-annual office visits for cleaning, X-rays and sealants.
Basic procedures are treatment for gum disease, extractions, fillings, and root canals, with deductibles, copays and coinsurance determining your out-of-pocket expenses. Most policies cover 70% to 80% of these procedures, with patients paying the remainder.
Major procedures such as crowns, bridges, inlays and dentures are typically only covered at a high copayment, with the patient paying more out-of-pocket expenses than other procedures. Every policy differs in how procedures are categorized as preventive, basic and major, so it is important to understand what is covered when comparing policies, which we’ll help you do. Some policies group root canals as major procedures, while others treat them as basic procedures and cover much more of the cost.
Most family dental insurance policies do not cover any costs for cosmetic procedures such as teeth whitening, tooth shaping, veneers and gum contouring. Because these procedures are intended to simply improve the look of your teeth, they are not considered medically necessary and must be paid for entirely by the patient. Some policies cover braces but usually require paying for a special rider and/or delaying braces for a lengthy waiting period.
This plan allows you to pick from a wide range of dental providers and your plan pays a percentage of the provider’s fee. The deductible may be lower than other plans and the annual maximum coverage limit may be higher.
An insurance deductible is the minimum amount that must be paid before the insurance policy pays for anything. If you have a fee-for-service benefit plan, your plan pays a predetermined percentage of the treatment cost and you’re responsible for paying the balance. This part of your out-of-pocket costs is known as “coinsurance” or a “copay.”
With indemnity plans, the premiums you pay monthly tend to be higher than other plans. You’ll be paying your share of service costs up front. This plan is best if you have a certain dental provider you want to see, or you anticipate needing major, costly procedures.
With a PPO, you pay lower fees to see certain in-network or “preferred” providers and higher fees if you see a provider out of the network. Insurance usually pays more for PPO plans than for indemnity plans or HMO plans, and often has a maximum reimbursement amount in a calendar year. Keep in mind that some procedures may not be covered or may have a waiting period before coverage starts.
This plan is best if you don’t need major dental work right away, but want to be prepared in case you need it in the future. Also, if you’d like some flexibility in your choice of dental providers but don’t want to pay high premiums.
With an HMO, you’re required to see dental providers in the insurance network, so choices are more limited. Preventive services—cleanings and X-rays—will be 100 percent covered, while basic procedures come with a co-pay. You may not have a deductible or maximum annual limit and premium payments will likely be lower.
Major or restorative procedures may come with less than 50 percent coverage or no coverage at all. This plan is best if you don’t anticipate needing any major dental procedures in the near future, or you have no provider preferences as long as basic dental work is covered financially.
Ready to get family dental insurance? Your smile will thank you! We’re here to listen to your questions and help you get answers. Sometimes talking over the phone is easier.
Call us at (831) 637-8941.