Dental insurance is a form of

health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...

designed to pay a portion of the costs associated with dental care.

American dental insurance

The

American Dental Association The American Dental Association (ADA) is an American professional dental association. Established in 1859 and with over 159,000 current members, ADA is the world's largest and oldest national dental association. The organization lobbies on behal ...

has lobbied against the US government providing dental insurance coverage for all Medicare recipients. In the US, two-thirds of dentists do not accept dental insurance through Medicaid. Medicaid covers both basic and emergency dental care for children while it only covers emergency care for adult Medicaid recipients.

Indemnity Dental Insurance Plan

With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements,

waiting period A waiting period is the period of time between when an action is requested or mandated and when it occurs. In the United States, the term is commonly used in reference to gun control, abortion and marriage licences, as some U.S. states require ...

, stated

deductible In an insurance policy, the deductible (in British English, the excess) is the amount paid Out-of-pocket expenses, out of pocket by the policy holder before an insurance provider will pay any expenses. In general usage, the term ''deductible'' m ...

, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.

Dental Health Maintenance Organization (DHMO)

Dental Health Maintenance Organization plans entail dentists contracting with a dental insurance company that dentists agree to accept an insurance fee schedule and give their customers a reduced cost for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods and no annual maximum benefit limitations, while covering major dental work near the start of the policy period. This plan is sometimes purchased to help defray the high cost of the dental procedures. Some dental insurance plans offer free semi-annual preventive treatment. Fillings, crowns, implants, and dentures may have various limitations.

Participating Provider Network (PPO)

In the United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to a DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified.

Payouts

Dental insurance companies divide benefits, services, or procedures into categories and refer to them with American Dental Association (ADA) 3-4 digit code. As an example, Preventive and Diagnostic procedures often include exams (ADA code 0120),

x-rays An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

(ADA code 0210), and basic cleanings or

prophylaxis Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental health a ...

(ADA code 1110). Basic procedures often include fillings, periodontics,

endodontics Endodontics () is the Specialty (dentistry), dental specialty concerned with the study and treatment of the dental pulp. Overview Endodontics encompasses the study (practice) of the basic and clinical sciences of normal dental pulp, the etiolo ...

, and

oral surgery Oral and maxillofacial surgery (OMFS) is a surgical specialty focusing on reconstructive surgery of the face, facial trauma surgery, the mouth, head and neck, and jaws, as well as facial plastic surgery including cleft lip and cleft palate ...

. Major procedures often are crowns,

dentures Dentures (also known as false teeth) are prosthetic devices constructed to replace missing teeth, supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable ( removable partial denture or comp ...

, and implants. Procedures such as periodontics,

, and

may be considered major, depending on the policy. Some dental insurance plans may have an annual maximum benefit limit. Once the annual maximum benefit is exhausted any additional treatments may become the patient's responsibility. Each year, the annual maximum is reissued. The reissue date may vary as a calendar year, company fiscal year, or date of enrollment based on the specific plan.

References

External links

Dental plan benefit models
from the

{{Insurance Dentistry Health insurance