Dental insurance is different from dental benefit for the fact that the former pays for the cost of treatment while the latter is meant to offset the additional cost after paying out of your pocket. In other words, the insurance will cover the cost of the root canal or getting tooth pulled as well as preventive services whereas the benefits cover only some of these services and in some cases nothing.
There are many different dental plans to choose from and offered by mediocre to best dental insurance companies. The fine prints that come with your plan says it all - what is covered and what is not covered in the plan of your choice. Note that medical insurance like Medicare doesn't cover dental care, and most state Medicaid programs cover the cost for children below the age of 19. In general, you will have the below mentioned options:
PPO or Preferred Provider Organization: PPO plans contain a list of dentists that you can consult with who will accept the plan you are assigned to. However, going out-of-network will require that you pay for almost all of the expenses.
DHMO or Dental Health Maintenance Organization: This is very similar to a medical HMO plan in that the dentists within the network will provide the service to you for free or a small fee. The plan comes with zero or set co-pay. You may not be covered by out-of-network providers though.
Discount Dental Plan: This is not an insurance but rather a discount for dental services. You pay the actual cost minus the discount offered by your treating provider. The discount may vary from one provider to another. So, just like a pharmacy discount, this plan doesn't cover the cost of dental services but instead offers the service for a reduced price.
Most dental insurance plans cover some or all of the cost of preventive care, root canals, fillings, surgery, tooth extraction, and other procedures. Some of the best plans will cover Periodontics, Orthodontics, Prosthodontics and other areas of dental service that include dentures, bridges, tooth support, health and well-being. The preventive care is paid for by the plan twice a year. You may not be covered Periodontics or Prosthodontics for the first year of coverage.
Other services may require a rider along with an additional fee. In general, most dental plans offer 100-80-50 coverage. This means it will cover preventive care 100 percent, basic dental service at 80 percent and major or complicated procedures at 50 percent. With cheap plans, the co-payment may be high, and some equipment cost may not be covered at all.
Every dental plan has its own set cap for payment during the plan year. This is called the annual maximum. Expenses incurred beyond this maximum are not covered by the plan. For example, most dental Preferred Provider Organization or PPO plans have an annual maximum of $1,500. The insurer is responsible for any cost beyond that amount. Note that, most major procedures such as root canal treatment and oral surgery can easily reach this threshold.
Dental care physicians suggest people to visit their dentists at least twice a year. Every six months, the plan provides the cost of dental cleaning and other preventive care services. You need to read the policy in length to learn about what is covered by your plan and what is not covered or partially covered.
This will help you make the appointment or have the procedure that you have been putting off accordingly. Certain time limits are also imposed on various dental services, such as fillings, X-rays, crowns and bridges. For instance, crowns and bridges on the same tooth is covered just once a year according to most plans. X-rays on the full set of teeth is offered once in 3 years by some plans. Fillings on the same tooth have time limitations as well. The exact benefits and drawbacks of the plan can be uncovered by reading the policy that you are enrolled in.