Navigating Dental Insurance Plans

By Danielle Hodges, Office Manager

Having been in the dental field for over 10 years, I am frequently asked these two questions: “What does my dental insurance cover?” and “What is a good dental plan to get?”

Usually these simple questions cannot be answered in a few short sentences; however there are some basic guidelines that can apply to most dental plans and can help you navigate through your plan or decide on a dental plan in which to enroll. It is important to understand the different types of dental plans, whether offered through an employer or self-funded.

• PPO (Preferred Provider Organization) plans are the most traditional. These plans allow you to see any provider of your choice, with either in-network or out-of-network benefits.

• DHMO (Dental Health Management Organizations) plans require you to choose a primary dentist who will be responsible for managing and coordinating your dental needs. There are no out-of-networks benefits with a DHMO dental plan and you will be subject to only being able to see that chosen dentist or pay 100% of the fees with any other provider.

• Dental Discount Plans have increasingly become an alternative to traditional insurance. These plans are just that, discount plans, that offer a percentage discount, usually 10-15% when you go to a preferred provider.

Williamsburg Center for Dental Health is a Premier Provider for Delta Dental and a Participating Provider for United Concordia insurance companies. We file and accept all other PPO insurance companies as an out-of-network provider. Not all dental plans are created equal, but a standard PPO should cover between 80 to 100 percent of the cost for regular checkups, cleanings, fluoride and sealants. For basic restorative work such as fillings and extractions, the coverage is usually between 50 to 80 percent. For major restorative work such as crowns, implants, and removable appliances, the coverage by insurance may range from 40 to 50 percent.

You will also want to keep in mind the cost you’ll pay for each service. Dental plans come with a deductible, which can range from $25 to $100, and need to be met once per year per family member. In addition, most plans have a maximum payout each year, often between $1,000 to $2,000 per family member. In most cases your dental benefits can be maximized to optimize your benefits by strategically planning your dental treatment; however this is not to say that your dental benefits should dictate your dental treatment needs; you only make them work for you.

As always I am dedicated to helping you, our patients, in any way possible. I am here to help you navigate through either your existing dental plan or help you if you are in the process of enrolling in new dental insurance.