Dental Insurance FAQs
1. Do you accept my dental insurance?
We accept most dental insurance plans. Call us for a free benefits check, and we’ll let you know exactly what your plan covers before any treatment.
2. What does my dental insurance cover?
Coverage varies, but most plans include:
✅ Preventive care (cleanings, exams, X-rays)
✅ Basic treatments (fillings, extractions)
✅ Major procedures (crowns, dentures, root canals)
3. What’s the difference between in-network and out-of-network dentists?
In-network dentists have an agreement with your insurance provider to offer services at pre-set rates. However, out-of-network dentists can often provide similar pricing and more flexibility in treatment options without being restricted by insurance contracts. Choosing an out-of-network provider ensures you receive the best care tailored to your needs, while still allowing you to use your benefits. We’re happy to check your coverage and help you understand your options!
4. Does my insurance cover cosmetic dentistry?
Most dental insurance plans do NOT cover cosmetic procedures like whitening and veneers. However, some plans may cover crowns or orthodontics if they are medically necessary.
5. How do dental insurance deductibles and annual maximums work? A deductible is the amount you pay before insurance starts covering costs. An annual maximum is the most your insurance will pay in a year.
- ✅ A deductible is the amount you pay before insurance starts covering costs.
- ✅ An annual maximum is the most your insurance will pay in a year.
6. What happens if I reach my annual maximum?
Yes, professional teeth whitening is safe and effective. Results can last from 6 months to 2 years, depending on your diet and oral hygiene habits.
How Does the Annual Maximum Work?
- ✅ Every dental insurance plan has a set annual maximum, which typically ranges from $1,000 to $2,500 per year, depending on your plan.
- ✅ This limit applies to all dental care you receive—not just at your general dentist, but also at any dental specialist you visit (such as an oral surgeon, periodontist, or endodontist).
- ✅ If you see both a general dentist and a specialist in the same year, all claims submitted will count toward the same annual maximum.
Example of How the Annual Maximum Affects You
Let’s say your dental insurance has a $1,500 annual maximum and you need the following treatments in one year:
- ✅ Two cleanings & exams: Covered 100% (does not reduce your maximum)
- ✅ Filling for a cavity: $200 (covered at 80%, so $160 is paid by insurance, $40 by you)
- ✅ Dental crown: $1,200 (covered at 50%, so $600 is paid by insurance, $600 by you)
- ✅ Root canal from a specialist: $900 (covered at 50%, so $450 is paid by insurance, $450 by you)
Total amount used by insurance: $1,210
Remaining annual maximum: $290
If you need another procedure after reaching your limit, you would be responsible for the full cost until your benefits reset (typically January 1st).
How to Make the Most of Your Annual Maximum
- ✅ Plan major treatments strategically: If you need extensive dental work, we can help you spread treatments across two benefit years to maximize coverage.
- ✅ Use your benefits before they expire: Any unused portion of your annual maximum does NOT roll over to the next year—so use it before you lose it!
- ✅ Check your benefits early: We offer free benefits checks to help you understand how much of your annual maximum is available and plan accordingly.
Dental insurance can be confusing, but we’re here to help! Give us a call, and we’ll explain everything before starting treatment so you know exactly what’s covered.
7. Will my insurance cover dental implants or dentures?
Some PPO plans provide limited coverage for implants, while most cover dentures. Check with your provider.
8. What’s the difference between a copay and coinsurance?
- ✅ Copay: A fixed amount you pay per visit.
- ✅ Coinsurance: A percentage of treatment costs you pay after your deductible is met.
9. Can I use both dental insurance and a dental savings plan?
10. Does my plan cover orthodontic treatment like Invisalign?
Some plans cover orthodontics for children and a few offer partial adult coverage.
11. What should I do if my claim is denied?
We help submit and appeal claims, but coverage decisions are between you and your insurance provider.
12. Can I finance my treatment if my insurance doesn’t cover it all?
Yes! We offer flexible financing options to make treatment affordable.
13. Does My Insurance Cover Emergency Dental Care?
Some dental insurance plans cover emergency exams and extractions, but coverage varies depending on your specific policy.
Key Things to Know About Emergency Dental Coverage:
✅ Many plans cover emergency exams, but the extent of coverage for treatments like extractions, root canals, or repairs depends on your policy.
✅ Some insurance companies only cover emergency care if it’s performed by an in-network provider, so check your plan before seeking treatment.
✅ If you need treatment outside of normal business hours, there may be an additional fee to open the office for emergency care. This fee may or may not be covered by your insurance, so it’s important to ask both your insurance provider and the dental office about potential out-of-pocket costs.
✅ If you’re traveling, some plans will reimburse you for emergency care received out of state or abroad, but you’ll need to check the details of your policy.
Emergency dental situations can be stressful, but we’re here to help. If you’re experiencing a dental emergency, call our office right away, and we’ll guide you through your options, including checking your insurance benefits before treatment.
14. What’s the Difference Between PPO, HMO, DMHO, and Dental Plans?
Dental coverage comes in different forms, and it’s important to understand the differences so you can choose the best option for your needs.
PPO (Preferred Provider Organization) Plans
✅ More flexibility—you can see any dentist, in-network or out-of-network.
✅ Higher monthly premiums but lower out-of-pocket costs when visiting an in-network provider.
✅ You may have an annual maximum, a deductible, and coinsurance for services.
✅ Coverage for preventive, basic, and major dental work varies by plan.
HMO/DMHO (Dental Health Maintenance Organization) Plans
✅ Lower monthly premiums but requires you to stay within a specific network of providers.
✅ No annual maximums—but coverage is limited to participating providers.
✅ Typically, no deductible, but you may have copays for services.
✅ Specialist visits may require a referral from your primary dentist.
Medicaid & Medicare Dental Coverage
✅ Coverage varies by state and specific Medicare plan.
✅ Medicaid may cover basic dental services like exams, cleanings, and extractions, but major procedures (like crowns or implants) are often not included.
✅ Traditional Medicare (Part A & B) does not cover routine dental care, but some Medicare Advantage (Part C) plans may offer dental benefits.
Dental Discount Plans (Not Insurance)
✅ Dental plans are NOT insurance—instead, they offer discounted rates for services at participating providers.
✅ No waiting periods, deductibles, or pre-existing condition exclusions—you can use the plan immediately.
✅ Some dental plans cover cosmetic procedures like whitening and veneers, which traditional insurance does not.
✅ You pay a membership fee for access to discounted services instead of paying monthly insurance premiums.
Important Considerations
> You generally cannot have both a dental insurance plan and a dental discount plan at the same time—most insurance carriers do not allow combining them, and claims could be denied.
> Always check with your provider for the details of your specific coverage.
Our office is happy to review your benefits and help you understand your options before any treatment.
15. What happens if I reach my annual maximum?
You’ll have to pay out-of-pocket until your benefits renew, usually on January 1st.
16. When do my dental benefits reset?
Most plans reset on January 1st. Use your benefits before they expire!