Dental Insurance

When evaluating a dental insurance plan (or when comparing two or more plans), several factors are important to consider to ensure it meets your needs: Coverage Limits and Annual Maximums: This refers to the maximum amount a plan will pay for dental services in a year. Higher annual maximums offer…

The medical-dental connection acknowledges that oral health is closely linked to overall health. Some medical insurance plans recognize this by providing limited dental coverage, especially when dental issues may affect medical conditions or when medical conditions impact dental health (e.g., diabetes affecting gum disease). However, most comprehensive dental coverage is…

Coinsurance in dental insurance is the percentage of the cost of a service that the patient is responsible for after the deductible is met. Common coinsurance levels vary by service type: preventive care might have low or no coinsurance (e.g., 0-20%), basic procedures might have moderate coinsurance (e.g., 20-50%), and…

Out-of-network dental claims can be paid based on either “Maximum Allowable Charge” (MAC) or “Reasonable and Customary” (R&C) rates. Under MAC, the insurer pays up to a scheduled amount for a specific service, regardless of the actual charge. R&C, on the other hand, pays based on the average rate for…

Dental insurance plans categorize treatments differently, and this includes periodontal (gum-related) and endodontic (root canal) treatments. Whether these treatments are considered basic or major services depends on the specific plan. Basic services often include routine procedures like fillings and extractions, while major services typically cover more complex work like root…