How dental insurance works

A premium is what you or your employer pay each month to keep the plan active. A deductible is the amount you pay each year before the plan starts paying its share of most basic and major services. Many plans cover routine exams and cleanings without applying the deductible. The annual maximum is the most the plan will pay toward your care in a plan year. Once you reach it, the rest of that year's care is your responsibility.

Many plans group services into tiers. Preventive care such as exams and cleanings is usually covered at the highest level. Basic care such as fillings comes next. Major care such as crowns, bridges, and implants is often covered at a lower level. Plans differ on where root canals fall: some treat them as basic and some as major, which changes your share of the cost.

An in-network dentist has signed a contract with an insurance company and agreed to its fee schedule. An out-of-network dentist hasn't. Many PPO plans still pay benefits when you see an out-of-network dentist, usually reimbursing you directly, though the amount can differ from in-network benefits. HMO-style plans (often called DHMOs) usually pay only for in-network care. Before your visit, check whether your plan includes out-of-network benefits.

Many people search for dental insurance that covers root canals immediately. Plans like that are uncommon. Most individual plans have waiting periods before they cover basic and major work, often around six months for basic care and a year or more for major care. Preventive care is usually covered right away. Some plans waive waiting periods if you had continuous coverage before, and employer plans often have shorter waiting periods or none. Plans may also exclude problems that started before you enrolled. Always read the waiting period and exclusions sections before you buy a plan for a specific treatment.

If you have tooth pain now, don't wait for coverage to start. An infected tooth can get worse, and saving it early is often simpler than treating it later. We can examine the tooth, explain your options, and help you plan how to pay.

Implants and Root Canals Inc. is an out-of-network, fee-for-service office. We aren't contracted with insurance companies, so we base treatment recommendations on what helps you, not on what a plan will cover. You pay the office directly for your care. If your plan has out-of-network benefits, you may be able to seek reimbursement from your insurer. Call us and we'll explain how that usually works. We also offer financing through CareCredit^® and Proceed Finance to help spread out the cost.