6 Answers to Your Questions about How Dental Insurance Works

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Dental work is not exactly the most exciting thing to spend Hawaiian-vacation-caliber money on. When it comes to pricetag anxiety, expensive dental work is right up there with roof repair, plumbing work and taxes: All things we know are necessary, but hope we don't end up with an unexpected bill for today. Alas, that day comes for all of us. And that's when you want to know the ins and outs of how, exactly, your dental insurance works. Or dental insurance plans, plural, if you're covered by more than one plan at the same time. It can get confusing quickly in these cases, and you might find yourself wondering which insurance is considered primary, which is secondary, or what that even means. That's why we've answered six common questions about dental insurance, including details on primary and secondary insurance, to help you through the process.

Q: Are health insurance and dental insurance the same thing?

A: Not exactly. A general health insurance plan may include some dental benefits, but not all do. It's important to check the fine print for this aspect of coverage when choosing a healthcare plan. If you're already covered, you can call your provider for a detailed rundown. And if you're covered through work, your human resources department can help answer any questions, too. Whatever your coverage, whether you're not covered at all, covered by an individual plan or covered through your employer, we have some additional information about affordable dental care, as well.

Q: Are all dental plans the same?

A: Definitely not. Just as health insurance plans in general vary widely, dental coverage also takes many forms. If you are in the process of shopping for a plan, you might want to find out more about the three main types: Health maintenance organization, preferred provider organization, and indemnity plans.

Q: What if I have more than one plan?

A: This happens! It's not uncommon for people to be covered by two or more dental plans at the same time. When this happens, you have a primary plan, a secondary plan, and to determine which plan pays out when, companies follow a process called coordination of benefits (COB).

Q: When do people have more than one dental plan?

A: It can happen when two spouses are each subscribed to their employer-provided dental healthcare plans but both plans also cover their spouse, when dependents are covered by both parents' dental plans, or if someone has coverage from government programs such as TRICARE (for active military) or Medicaid (which usually only includes coverage for children).

Q: Which plan pays first?

A: The plan that pays first is considered the primary plan. This is determined by COB, which is usually dictated by state and government regulations. Generally, the primary plan is the one in which the patient is the main policyholder. The secondary plan is the plan that the patient is covered as a dependent.

Q: What happens after the primary plan pays the benefits?

A: After the primary plan processes and pays a claim, the secondary plan will process the claim to see if they cover any of the remaining balance. Combined, the benefits should not exceed 100% of the total charges. In the case of children covered by both parents' plans, the primary and secondary details will be sorted according to state laws or, if applicable, any custody agreements that are in place.

 

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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What To Expect During a DENTAL VISIT

On your first visit, your dentist will take a full health history. On follow-up visits, if your health status has changed, make sure to tell your dentist. Here’s what you can expect during most trips to the dentist.

  • A Thorough Cleaning – a dental hygienist or dentist will scrape along and below the gum line to remove built-up plaque and tartar that can cause gum disease, cavities, bad breath and other problems. Then he or she will polish and floss your teeth.

  • A Full Dental Examination – your dentist will perform a thorough examination of your teeth, gums and mouth, looking for signs of disease or other problems.

  • X-Rays – X-rays can diagnose problems otherwise unnoticed, such as damage to jawbones, impacted teeth, abscesses, cysts or tumors, and decay between the teeth.