What’s Covered & What’s Not: Understanding Your Dental Insurance Benefits

It is never a good feeling opening your mail to find a bill for something you expected your dental insurance to cover. To avoid unwanted surprises, it is essential to read up on your dental plan and policy. This way you will have a full understanding of your dental cost obligations.

Nevada Sun Dental would like to help dispel some of the mystery, so we have put together a brief overview of dental insurance in Nevada and its coverage:

Why Dental Insurance is Important

Though insurance does not necessarily pay the entirety of your dental bill, it is still a significant benefit. As both medical and dental costs are pricey; having insurance that pays at least a portion of the bill allows you to avoid paying a portion out of pocket.

Whether you get your insurance from an employer or through a health exchange, possessing dental insurance is always a smart idea in case you run into unexpected health concerns.

Common Dental Insurance Terms

When it comes to insurance, there are a lot of confusing terms thrown around. Here are some of the most important terms that dental insurance in Nevada stipulates within a policy and their meanings:

COPAY: A fixed amount that you pay out of pocket for your treatment. This is the portion of the bill that you cover.

COINSURANCE: Like a copay, coinsurance is a percentage of your bill that you are responsible for paying.

DEDUCTIBLE: Most insurance plans have a deductible which is a set amount of money spent on services each year.  Once you hit this amount, you no longer have to pay out of pocket, and the rest is covered fully by your insurance up to a specified amount.

MAXIMUM: A maximum is a total amount your insurance company will pay during a benefit year. If you hit your maximum and still have treatments before the new benefit period begins, you will have to pay the rest of the costs out of pocket.

Types of Plans and What They Cover

The type of plan that you have dictates what you will pay out of pocket. When deciding which dental insurance in Nevada to go with, make a note of your personal dental history so you can choose what level of care works best for you.

The Most Common Dental Insurance Plan Types Include:

Managed Care Plans: These plans are common through employers and tend to be low cost as they have more treatment and payment restrictions. They are an excellent option for basic dental care, especially if you have good oral health. With this type of plan, you generally must pick a dentist within a network.

Fee-for-service Plans: These plans tend to be more expensive because you get the freedom of choice. You can generally pick any dentist you want. These plans also have the most coverage, so if you or a dependent will need more dental work, this is the best plan for you.

Procedures Covered

Because all plans are so different, coverage can vary. Study your dental insurance plan booklet and get your questions answered by your HR team or benefits coordinator. Your plan will specify what procedures are covered and how much you can expect to pay out of pocket within your deductible and maximum limits. Most preventative treatment is fully covered while various procedures ―like crowns― require a copay.

If you are concerned about whether your insurance covers a dental procedure or if you want to get an accurate price, request a pre-treatment estimate from your dentist. While your dentist can provide you with numbers, keep in mind that your insurance plan sets your coverage. If your insurance provider does not cover a specific procedure, your dentist has no control.

Get in Touch

If you’re in need of dental work or preventative treatment, schedule an appointment with the friendly dentists at Nevada Sun Dental. We work with all the top insurance companies to give you the best service possible while keeping your out of pocket costs low. Should you have any questions about your dental insurance in Nevada, please don’t hesitate to inquire

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