How Does Dental Insurance Work Modesto, CA
Many people are unaware of how dental insurance works. Fortunately, dental insurance plans are more straightforward and easier to understand than health insurance plans. Our team can help you learn about dental insurance plans, options, and how to make informed decisions about your oral health.
At Great Smiles Dental, we accept various dental insurances. If you are in Modesto and the surrounding area, call us today at (209) 222-3636 to schedule an appointment or learn more about our accepted dental insurance plans.
Shopping for Dental Insurance
When shopping for dental insurance, it is essential to keep one's ideal provider in mind. After all, dental insurance can only get one so far if it leads them to the wrong dentist. If possible, patients should check each provider's directory of dentists within their network before choosing a plan.
This can usually be done online or over the phone. If the provider they want is not in a certain dental insurance carrier's directory, they can move on to the next insurance company. However, patients who are open to seeing a different provider may choose to shop around for another dentist.
“When shopping for dental insurance, it is essential to keep one’s ideal provider in mind.”
Coverage for Dental Procedures: Types of Coverage Available
Plenty of options exist for dental insurance. This can be good, as plans cater to a wide range of needs. The types of coverage, premiums, and deductibles can vary — which can be confusing.
Consider the following when choosing dental insurance:
Find Out What Plans are Available in Your Area.
Start by narrowing your search to dental plans available in your city and state. Some insurance companies do not offer coverage throughout the United States, so keep things simple by comparing plans available in your area.
Look for a Plan that Has Many Dentists and Dental Practices.
Whether one currently has a preferred dentist or not, it is essential to consider having more than one option. An insurance company that covers many dentists and providers typically remains in good financial standing with a solid reputation — meaning that claims will likely be reimbursed on time.
Consider All Costs.
When searching for a dental insurance provider, patients should first consider the monthly premium and deductible. They should also consider the amount they will have to pay out-of-pocket for dental services (copays) before insurance kicks in.
The maximum annual limit is also essential to note. Most insurance companies put a cap on the amount they will reimburse each year. Once this cap has been reached, all the patient's dental expenses will be out-of-pocket. Patients should pay particular attention if they have extensive dental issues that need to be addressed.
Most routine dental treatments remain covered under dental insurance, but many plans do not cover "extras," such as whitening or sealants. Check with the insurance carrier to learn about covered procedures. Also, be aware that some insurance plans have required waiting periods — leaving patients waiting a long time for coverage on specific procedures — especially the more expensive ones.
“Plenty of options exist for dental insurance. This can be good, as plans cater to a wide range of needs.”
Purchasing Dental Insurance
Purchasing dental is a personal issue and depends on how much dental work the patient needs and how many family members they have. Generally, the more dental work required and the more family members, the more value for the month.
The typical dental insurance plan covers preventive care: checkups and cleanings at 100% (no deductible), basic procedures (e.g., fillings and extractions) at 70%, and major procedures (e.g., crowns, bridges, and root canals) at 50%. Some procedures may be considered basic by one carrier and major by another, so patients must speak with their insurance carrier before getting dental treatments to understand the breakdown of costs and coverage.
Like health insurance plans, dental plans typically have a deductible — the amount one has to pay out of pocket each year before the plan starts to cover its portion of costs. Most plans cap the total amount they will pay for care per plan member per year. Any dental expenses over the plan's cap (or maximum) become the patient's responsibility.
“Purchasing dental is a personal issue and depends on how much dental work the patient needs and how many family members they have.”
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Individual vs. Family Dental Insurance
While some patients only need coverage for themselves, others may require coverage for the entire family. Both individual and family dental insurance plans can be purchased through the U.S. government's Marketplace or directly through a carrier. However, premiums for individual plans are typically lower than for family plans, as they involve only one individual.
In contrast, family dental insurance plans generally have higher premiums. However, most allow for two annual exams per plan member. It is essential for patients to find the right type of coverage for them – and, if applicable, their families – that still remains affordable.
“While some patients only need coverage for themselves, others may require coverage for the entire family.”
Questions Answered on This Page
Q. What should I look for when choosing dental insurance?
Q. Is dental insurance worth it?
Q. What options are there for dental insurance?
Q. How can I find dental insurance that takes my ideal dentist?
Q. What are the differences between family and individual dental insurance?
People Also Ask
Q. Who is the billing specialist?
What to Consider When Purchasing Dental Insurance
With so many options available, it can be difficult for patients to know which dental insurance plan fits their needs best. In many cases, the plan offered by their employer or professional association represents the best fit.
It may be helpful for patients to talk to their dentist to see what plans their office recommends and accepts. If patients do not currently have a dentist, they will want to look for a plan that provides the coverage they need at an affordable price. If they know they need major dental work, they should look for a policy with a high spending cap. If they have minimal dental needs, selecting a partial coverage plan may be the most fiscally responsible decision.
“It may be helpful for patients to talk to their dentist to see what plans their office recommends and accepts.”
Frequently Asked Questions
Q. Can I be covered under multiple dental insurance plans?
A. You may, but one plan will probably be considered your primary plan. If this is the case, the primary plan will go toward your dental care first, with the other plan(s) covering the remaining costs. However, the plans cannot cover more than 100% of the treatment cost.
Q. What are the different kinds of dental plans?
A. Like health insurance plans, dental insurance plans are generally categorized either as Indemnity (e.g., HMO) or managed-care (e.g., PPO) plans. These plans mainly differ in the patient's choice of providers, how expenses are paid, and out-of-pocket costs.
Q. Why is dental health important?
A. Many people mistakenly believe that dental health is isolated from overall health. In reality, each system of the body is interrelated. In other words, neglecting your oral health could easily have disastrous effects on your overall health.
Q. Do I really need a dental insurance plan?
A. Yes. It can be costly to keep up with dental health, especially if you are making your routine checkups and cleanings as directed. Choosing the right dental insurance plan can help keep costs low while promoting proper healthcare.
Q. Whom should I talk to about any questions I have about my dental insurance plan's benefits or a claim?
A. It is best to directly contact your insurance carrier for any questions and concerns about your benefits or claims.
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Dental Terminology
Call Us Today
If you have questions about dental insurance options or whether or not a service is covered, call Great Smiles Dental in Modesto at 209-222-3636 to learn more.
Helpful Related Links
- American Dental Association (ADA). Glossary of Dental Clinical Terms. 2024
- American Academy of Cosmetic Dentistry® (AACD). Home Page. 2024
- WebMD. WebMD’s Oral Care Guide. 2024
About our business, license, and website security
- Great Smiles Dental was established in 2014.
- We accept the following payment methods: American Express, Cash, Check, Discover, MasterCard, and Visa
- We serve patients from the following counties: Stanislaus County and San Joaquin County
- We serve patients from the following cities: Modesto, Oakdale, Turlock, Tracy, Stockton, Lathrop, Ripon, Atwater, Salida, Manteca and Ceres
- CA (License #33512). View License Information and Specifics
- National Provider Identifier Database (1629180617). View NPI Registry Information
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