Medplex Helps Explain Dental Benefits and Deductibles

Choosing to carry dental insurance may be beneficial for you as the 2019 plan year begins. However, all dental insurance plans are different and understanding the benefits can be somewhat confusing. For example, some benefits renew on the initial coverage date and others reset at the beginning of a new year. Some health insurance plans cover preventive dental care and certain procedures are covered on some plans and not others.

When considering plans, you may come across the information mentioned later in this post. Medplex Pediatric Dentistry takes multiple forms of dental and health insurance, however, there are thousands of different types of plans, so it’s important to arm yourself with these key terms to become knowledgeable of what may or may not be covered.

Medplex recommends the following information from WebMD:

Types of Plans

Preferred Provider Organization (PPO)As with a health insurance PPO, these plans come with a list of dentists that accept the plan. You can go out of network, but your out-of-pocket costs will be higher.

Dental Health Maintenance Organization (DHMO): Like a health insurance HMO, these plans provide a network of dentists that accept the plan for a set co-pay, or no fee at all. However, you may not be able to see an out-of-network dentist.

Discount or referral dental plan: This is a plan in which you get a discount on dental services from a select group of dentists. Unlike health insurance, the discount or referral plan doesn’t pay anything for your care. Rather, the dentists who participate agree to give you a discount for the care you receive.

Plan Comparisons

As you compare plans, try to find out the following things:

  • Whether your dentist and any specialists you may need are in network
  • Total costs for the plan each year, including premiums, co-pays, and deductibles
  • Annual maximum
  • Out-of-pocket limit, if any
  • Limitations on pre-existing conditions
  • Coverage for braces, if needed or anticipated
  • Emergency treatment coverage, including treatment if you’re away from home

Adapted from on 11/28/18.

Medplex Pediatric Dentistry serves as a top rated pediatric dentist for Alabaster, Birmingham, Hoover, Helena, and Pelham, AL