Resources for Individuals

How Does Dental Insurance Work?

Mar 25, 2020 1:31:20 PM / by Erik Soderborg

Dental insurance, like all types of insurance, serves to protect you financially against things that may go wrong with your teeth and/or mouth. You pay a monthly payment (premium) that goes to an insurance company that is willing to take on the risk that you have dental work done.

Some people never get a cavity and will utilize their dental plan just to get their semi-annual cleanings and exams. Others, have mild to severe mouth problems that will require more work and cost more to handle.

Dental insurance serves you with three main benefits.

  1. The Network

    Dental insurance companies negotiate better rates with dentists than what would normally be charged. Since dental insurance companies typically represent a large number of people, they can negotiate lower rates because more of their members will visit in-network dentists. Your dental insurance company should have a large enough network of dentists that allows you to select between many high-quality dentists that can serve you and your family.

    To give you an example, this past year my family of 5 had several dental visits. We had our semi-annual cleanings and exams as well as a couple people in my family had cavities and work to be done. Had we not had a negotiated rate by our insurance carrier (EMI Health), the billed amount would have been $4,406. Instead, the billed amount was $2,284. That’s a 52% savings for those doing the math, simply because of the network rates EMI Health was able to negotiate.

    The other benefit of visiting in-network dentists is that these dentists have to meet a standard of quality and comply with the dental insurance company’s policies around procedures and payments. This helps protect you, the consumer, so you know you’re getting good care from in-network providers that follow approved guidelines.

  2. Insurance Coverage

    In addition to the savings you see from the network discounts, you also have certain amounts paid by your insurance company for specific procedures and services. For example, if you plan covers preventive visits 100%, your insurance company will pay for those costs. This means you can have your semi-annual checkups and not have to pay anything.

    In addition to preventive services, insurance covers basic(cavity fillings, oral surgery), major (crowns, bridges, prosthodontics), and orthodontics (braces). These typically come with a coinsurance amount that the insurance company agrees to pay. For example, your plan my cover 80% of all basic procedures. If you get a cavity filled and it costs $100, you would only be responsible for $20 while your insurance company would pick up the rest.

  3. Peace of Mind

    The last benefit you get with dental insurance is the peace of mind that comes from knowing your mouth is covered should something go wrong. We never know when a tooth with hurt, get chipped, or crack. Cavities come to the best of us and crowns happen. It’s nice knowing that whatever comes, you will save money from lower negotiated rates as well as an insurance company that will pay for a large percentage of your dental costs.

We’ll be open about all this. Dental insurance isn’t right for everyone. In fact, we wrote an article that helps people like yourself decide if dental insurance is worth it for you to buy. Do your research and plan with your family around whether or not you could benefit from having dental insurance.

 

Contact EMI Health today if you want to learn more about our Individual & Family Plans or our Federal Marketplace dental insurance options. 
These plans are not only affordable, but they also cover the basic and important care. In addition to Individual & Family plans and Federal marketplace plans, we also provide senior dental plans and a wide variety of health plans. Whatever your need may be regarding insurance, we've got you covered. Contact us today by calling 1-800-662-5851 or by visiting www.emihealth.com

 

Tags: dental, individual

Erik Soderborg

Written by Erik Soderborg

Erik is the Marketing Guy at EMI Health. He is passionate about people, tennis, and reading. He has a dry sense of humor and dabbles in the dark art of table tennis.