What is dental insurance & and how can it reduce the cost of our annual budget in 2022? A Complete Practical Guide.

“A confident smile comes from our heart, but a healthy smile comes from dentist-recommended medical methods and regular care.”

According to CDS (Centers for Disease Control and Prevention), “The CDC estimates that 47.2 percent of American adults suffer from some form of gum disease. That’s approximately 64.7 million people. Among adults age 65 and older, the rate of gum disease is as high as 70.1 percent.”

The source of the above information is taken from here: www.drdannyokeefe.com

The above information makes it very clear that US citizens need to be further educated on dental health and how to control their expenses.

The purpose of this article is to provide information to the readers about the different types of dental health insurance, as well as the education of the readers on what basis they should choose is also provided in this article.

What will get readers in this article (about what is dental insurance?).

This article has been published in seven parts to give readers more clarity and less confusion about Dental Insurance.

This article has been published after doing much research on dental insurance, so readers can rest assured that whatever information they get will be the latest in 2022.

What will get readers in this article (about what is dental insurance?).

This article has been published in 11 parts to give readers more clarity and less confusion about Dental Insurance.

This article has been published after doing much research on dental insurance, so readers can rest assured that whatever information they get will be the latest in 2022.

Part 1: Best ways to know: What is dental insurance, and how many types of dental insurance exist in the real world?

Part 2: Practical ways to know: How much coverage may cover dental insurance?

Part 3: Practical ways to know: What factors affect the cost of dental insurance premiums?

Part 4: Practical best tips: How to determine the best dental insurance program for a specific need?

Part 5: Best ways to know: Which organizations in the United States provide (low-cost treatment or some free dental care services) financial assistance for dental health care?

Part 6: Best ways to know: Is there a waiting period for dental insurance?

Part 7: Best ways to know: Under what circumstances do Medicare, Medicaid and TRICARE provide individual dental coverage for dental health facilities?

Part 8: Practical best tips: How to file a claim for dental insurance?

Part 9: Best ways to know: What is included in dental insurance, what is not and why does this happen?

Part 10: Practical best tips: How to file a complaint against an insurance company that doesn’t provide fair compensation for your dental insurance?

Part 11: Frequently Ask Questions about dental insurance commonly asked by the people.

Part 1: Best ways to know: What is dental insurance, and how many types of dental insurance exist in the real world?

What is dental insurance?

Dental insurance covers the cost of dental treatment required for the deterioration of dental health.

Example: Let us assume that the alignment of a person’s teeth is not normal naturally or due to some accident. In such a situation, that person will not be able to easily chew the necessary food taken daily, which will adversely effect his health.

We need to eat a certain amount of food every day. When that person is not able to chew his food smoothly every day, then he will have mental depression as well as its adverse effect will also be on his digestive system.

Note 1: In such an abnormal condition of the teeth, the health of a person is adversely affected and becomes a life-threatening situation. In such a situation, catastrophic health insurance is a worthy option for you. But there are certain criteria to get this.

Note 2: Some private group insurance companies offer coverage for various dental diseases, but this coverage applies to a specific dental disease or a specific insurance program.

What are the major types of dental insurance based on the trend?

There are mainly the following types of dental insurance based on the trend, it is shown below.

Types of dental insurance.

1. Dental insurance for braces

2. Dental insurance for dental fillings

3. Dental insurance for wisdom teeth removal

4. Dental insurance for implants

5. Dental insurance for invisalign

6. Dental insurance for bonding

7. Dental insurance for dentures

8. Dental insurance for night guards

9. Dental insurance for veneers

10. Dental insurance for bone grafts

1. Dental insurance for braces:

Braces are used when the structure of a person’s teeth is not in a natural alignment, and the structure of that person’s tooth is skewed.

Dental braces are a dental, medical treatment in which a high-quality metal wire is temporarily applied to the teeth; because of this, if the alignment of a person’s teeth is not proper, then their teeth are aligned by this dental, medical procedure.

• Braces dental insurance available for the cosmetic procedure: No
• When braces dental insurance is available for everyone: When necessary for human life.

2. Dental insurance for dental fillings:

When small holes are formed in the teeth due to overeating acidic food or any genetic cause, in this situation, the person gets an infection in the teeth, and experiences extreme pain all the time.

In such a situation, to remain medically healthy, the holes created in his teeth are filled through various types of dental, medical procedures; it is called dental filling medical procedures.

• Dental filling insurance available for the cosmetic procedure: No
• When dental filling insurance is available for everyone: When necessary for human life.

3. Dental insurance for wisdom teeth removal:

Removal of a wisdom tooth is a method in which it becomes necessary to remove it medically when there is an infection or other type of medical deformity in the wisdom tooth.

Remember that this medical procedure is different from a normal tooth extraction procedure and can be costly.

• Wisdom teeth removal insurance available for the cosmetic procedure: No
• When wisdom teeth removal insurance is available for everyone: When necessary for human life.

4. Dental insurance for implants:

A dental implant is performed through medical surgery; it is a complete dental, medical procedure. In this surgery, artificial teeth are put in place of broken teeth or damaged, and metal screws are used to install these artificial teeth.

• Teeth implants insurance available for the cosmetic procedure: No
• When wisdom Teeth implants insurance is available for everyone: When necessary for human life.

5. Dental insurance for invisalign:

Invisalign is a dental, medical procedure that uses a removable tray instead of metal wire (braces). It is a cheap and practical procedure for aligning crooked teeth.

The good thing about this is that this tray can be removed while eating and then you can put it back on your teeth. You do not need a dentist to do this procedure.

This medical procedure is more accurate than braces because digital imaging is used to make into the tray design.

• Invisalign insurance available for the cosmetic procedure: No
• When Invisalign insurance is available for everyone: When necessary for human life.

6. Dental insurance for bonding:

A tooth bonding dental, medical procedure is when a chipped and broken tooth is repaired. This dental medical procedure is also used to fill gaps between the teeth, and even lengthen a tooth hat’s shorter than the rest.

• Tooth bonding insurance available for the cosmetic procedure: No
• When tooth bonding insurance is available for everyone: When necessary for human life.

7. Dental insurance for dentures:

Dangerous is a medical procedure; if the teeth or gums in a person’s mouth are damaged, then using this medical procedure, artificial teeth or gums are placed in that person’s mouth. These are custom designed, so they visually match a person’s existing teeth or gum.

• Dentures insurance available for the cosmetic procedure: No
• When Dentures insurance is available for everyone: When necessary for human life.

8. Dental insurance for night guards:

A night guard is a piece of soft or hard plastic. It covers the bite surfaces inside the mouth and is worn as a set over or under the teeth. It is a useful dental procedure because it has a custom design, and we know that each person’s tooth structure is different, so it is a helpful method.

• Night guards insurance available for the cosmetic procedure: No
• When night guard insurance is available for everyone: When necessary for human life.

9. Dental insurance for veneers:

Veneers dental, medical procedure is the medical treatment of a person whose teeth are glued, there is a gap between the teeth or the uneven shape of their teeth. All these defects are eliminated by using this medical procedure.

• Veneers insurance available for the cosmetic procedure: No
• When veneers insurance is available for everyone: When necessary for human life.

10. Dental insurance for bone grafts:

A dental bone graft is a dental, medical procedure that is used for people who have had damage to the jaw bone in the mouth.

The material of bone graft can be of the following types, it can be taken from a person’s body (autogenous), or it can be taken from a human tissue bank (allograft) or an animal tissue bank (xenograft), but bone graft material can also be synthetic (alloplast).

• Bone graft insurance available for the cosmetic procedure: No
• When bone graft insurance is available for everyone: When necessary for human life.

Part 2: Practical ways to know: How much coverage may cover dental insurance?

How much does dental insurance cover the cost of a dental treatment procedure, and why?

Dental Insurance is majorly three factors that affect the cost of dental treatment procedures.

1. Routine and preventative dental, medical procedures.

2. General dental treatment procedure.

3. Serious dental treatment procedure.

1. Routine and preventative dental, medical procedure: This procedure includes routine and preventive dental medical treatment such as cleaning, check-ups, and x-rays. Mainly all this can happen every six months it depends on your insurance policy. Dental insurance can provide coverage up to 100% of the cost of it all.

2. General dental treatment procedure: Medical treatments such as dental filling extractions and root canals are covered under this procedure. Dental insurance can provide coverage for almost 80% of the cost of all these.

3. Serious dental treatment procedure: Serious dental, medical treatment procedures include dental treatments such as implants, bridges, crowns, and dentures. Dental insurance can provide coverage of up to 50% of the cost of serious dental treatment procedures.

Note: A dental insurance company determines the coverage to be provided by its dental insurance under a fixed costing formula. This is the reason different insurance companies have different dental insurance coverage.

What are the factors due to which the cost of dental insurance varies from state to state?

The cost of dental insurance varies from state to state, due to the following factors:

1. Dentist fees vary from state to state.

2. The cost to be charged by the hospital management on each patient varies from state to state.

3. The cost of medicines varies from state to state.

4. The fee for the laboratory medical test required for dental treatment varies from state to state.

5. Labor costs vary from state to state.

6. The cost of transportation is different in each state.

Does dental insurance compatible with Preferred Provider Organization (PPO) and Health Maintenance Organization (DHMO)? If yes what are the advantages and disadvantages of these?

Dental insurance is compatible with PPO and DHMO.

What is Dental PPO Insurance, and what are its benefits and limitations?

PPO dental insurance program premium costs more than the cost of DHMO dental insurance program. But PPO dental insurance plans are more flexible in terms of medical and convenience.

A PPO insurance plan has the following advantage, which is mentioned below:

1. A PPO dental plan provides a larger network of dental providers.

2. You can switch dentists or see a specialist without a referral from a primary care dentist.

3. You are not required to designate a primary care dentist when enrolling.

4. This program provides greater flexibility when choosing a dental facility or dentist.

5. You can get partial reimbursement when treated by an out-of-network dentist.

6. It has a large network of dentists.

A PPO insurance plan has the following disadvantages, which are mentioned below:

1. Premium cost is high.

2. You are required to meet the deductible amount.

3. PPO dental plans have an annual coverage limit.

4. Copayments may be higher with a PPO dental plan.

What is Dental DHMO Insurance, and what are its benefits and limitations?

DHMO insurance plans offer low-cost and regular dental visits and check-ups. It clearly defines out-of-pocket costs. Interestingly, there is no exclusion for existing conditions or missing teeth. It is designed for primary dental facilities.

A PPO insurance plan has the following advantage, which is mentioned below:

1. Lower premium cost.

2. No deductible.

3. There is usually minimal or no payment for preventive care and diagnostics.

4. There is no annual maximum limit for covered benefits.

A PPO insurance plan has the following disadvantages, which are mentioned below:

1. The size of the dentist’s network is small.

2. Requires a referral by a primary care dentist to receive specialist care.

3. This does not cover the cost of care for dentists who are out-of-network if they receive any dental treatment.

4. There may be restrictions on the estimated number of treatments, visits, and diagnostic tests.

In terms of dental insurance, what is the definition of detectable, copayment, dual coverage, and treatment limitations?

In terms of dental insurance, the definition of detectable, copayment, dual coverage, and treatment limitations is followings are as shown below:

1. Detectable:

Deductible expenses are expenses that patients pay before treatment, and the insurance provider pays for specified coverage expenses after the treatment is done, and patients receive a fixed reimbursement.

2. Copayment:

This is the share amount that the patient pays for the treatment, usually 1% of the dentist’s fee.

3. Dual coverage:

When more than one dental insurance plan covers the treatment of one disease of a person, then it is called dual coverage.

4. Treatment limitations:

If only a certain amount of medical procedures are covered per year based on a dental insurance plan, such a condition is called treatment limits.

Part 3: Practical ways to know: What factors affect the cost of dental insurance premiums?

What are the factors that affect the cost of dental insurance premiums and why?

Factors that affect the cost of dental insurance premiums are shown below:

1. Excessive amount of fluoride element in water.

2. Genetic diseases of teeth.

3. At your place of residence.

1. Excessive amount of fluoride element in water: If you live in a place where drinking water has a high fluoride element, the cost of your dental insurance premium may be high, or the insurance company may not cover you with dental insurance.

Due to the excessive amount of fluoride in the water, various types of problems in the teeth always remain.

2. Genetic diseases of teeth: If a severe type of dental disease is always found in your family, it can directly indicate that it may be a genetic disease. If you have a severe genetic disease of teeth, your premiums may cost more, or the insurance company may not provide you with dental insurance.

3. At your place of residence: If you live in a location where the cost of medical health services is high, the cost of your dental insurance premiums may be increased.

Part 4: Practical best tips: How to determine the best dental insurance program for a specific need?

Dental insurance for a specific need can be determined by following the steps shown below:

Step 1: Identify your specific need for dental insurance: First of all, you should make sure that for which dental treatment procedure you need dental insurance. To make this task easier, you should consult your dentist. Your dentist can provide you with accurate information about your dental disease.

Example:

If you need medical insurance for dentures treatment procedures and lack of knowledge, you get dental insurance for in implants dental procedures.

The medical procedure methods of these two dental treatments different, so their insurance cost of the premium is also different.

If you apply for compensation for your actual dental, medical treatment procedure, the insurance company may not easily provide it to you. You may have to go through financial and mental depression.

Step 2: You should make sure in which category you need dental insurance, such as routine and preventative services, basic services, and major services

Step 3: Amount of Dental insurance coverage: You should talk to your dentist to be sure and ask him how many teeth you have damaged, and based on that, you will be able to figure out how many teeth you need to have medical treatment. On that basis, you can determine the coverage of your dental insurance.

Step 4: For any dental, medical procedure you want to take dental insurance you should make sure that the insurance company will provide, you coverage for it or not.

Step 5: You should ensure that the insurance company will compensate you for this when you visit the doctor.

Step 6: If surgery is necessary for your teeth treatment, you should determine what percentage of the cost of the surgery will be covered by your insurance company and what percentage of the medical device will be covered if the surgery involves the use of a medical device.

Step 7: You must go to the dentist for your dental, medical treatment. For this, you will need transportation. Make sure that your insurance company provides compensation for the cost of transportation.

Step 8: You should ensure how long your insurance company takes to provide the indemnity; if it takes too long. Then it is only appropriate to get away from such an insurance company.

Part 5: Best ways to know: Which organizations in the United States provide (low-cost treatment or some free dental care services) financial assistance for dental health care?

The U.S. Department of Health and Services Administration (HRSA) supports and Human Services (HHS) Health Resources is variously federally funded and also supports community health centers.

These mainly provide low-cost or some free dental care services. These health centers provide your service even if you have opted not to take health insurance, and you can only pay what you want. When you need dental health care, all these centers help you with your checkup and treatment.

If you want to find the relevant health center in and around, you should use HRSA’s Find a Health Center. By doing this you can save your transportation cost and your precious time.

Part 6: Best ways to know: Is there a waiting period for dental insurance?

Yes there is a waiting period in dental insurance and this waiting period depends on the category (services) of dental insurance it is shown below.

1. Preventive category (services): 0 months

2. Basic procedures category (services): 3 to 6 months

3. Major services category (services): 12 to 24 months

Part 7: Best ways to know: Under what circumstances do Medicare, Medicaid and TRICARE provide individual dental coverage for dental health facilities?

1. Under what circumstances does Medicare provides dental coverage?

Part A of Medicare covers dental care such as care in skilled nursing facilities, hospital stays, and hospice care. Part A of Medicare pays for specific dental medical services provided during a hospital stay.

Example: Medicare covers hospitalization and medically necessary procedures until recovery if an accident results in a severe injury to a person’s teeth or jaw.

Note 1: Medicare Advantage (Part C): Paying the premium cost of a dental insurance policy from private insurance companies that are contracted with Medicare may cover your dental costs, but it should be in line with their guidelines.

Note 2: Original Medicare, which the federal government administers, primarily does not cover most routine dental care dental procedures and its supplies.

People insured by Medicare have to pay for the full cost of a dental cleaning, feeling, extraction, and dentures.

2. Under what circumstances does Medicaid provides dental coverage?

Medicaid provides dental benefits in two different ways, as shown below.

1. Each state determines whether or not to provide dental benefits through Medicaid for adults. If a state provides dental benefits to adults through Medicaid, it provides these benefits under certain criteria.

2. A child who is covered by a Health Insurance Program (CHIP) is required to provide dental benefits to such children. It mainly provides periodic screening and early, treatment (EPSDT) and diagnostic as dental benefits.

Dental services for children generally include the following minimum forms as shown below:

• Maintenance of dental health
• Restoration of teeth
• Relief of pain and infections

3. Under what circumstances does TRICARE provides dental coverage?

Dental insurance is different from general medical insurance similarly TRICARE’s medical coverage is different from dental coverage.

Dental coverage through TRICARE is available to serving servicemen and their dependents and retired servicemen but requires a special enrollment to get dental coverage through TRICARE.

When do adults receive full dental benefits through Medicare?

Adults get full dental benefits through Medicaid when he is medically necessary or that person needs emergency dental services, mainly most of the states provide it but the number of such states is very few.

Part 8: Practical best tips: How to file a claim for dental insurance?

Any person can file a claim for dental insurance in two ways:

1. Online.

2. Offline.

Even though this choice is up to you, which option you choose, in both the methods mentioned above, you have to fill in the same type of information together.

If you opt for the online option, you need to create an account by visiting your insurance provider’s website.

If you opt for offline, you need to visit your insurance provider’s website and download the claim form.

While claiming the dental insurance file, you should have your dental ailment, your doctor’s information, and the insurance policy taken you. In the absence of this information, you will not be able to claim the coverage of your insurance. The list of the necessary information is provided below.

1. Download the claim form according to your insurance policy.

2. Fill in all the details of the patient and the insurance provider in the form.

3. Provide detailed receipts and other medical documents provided by the dentist during the dental treatment that includes the following:

1. Dentist’s name, address, and phone number.

2. List of affected teeth.

3. Date each service was performed.

4. Dentist’s National Provider Identifier (NPI)

5. Dentist’s Tax Identification Number (TIN)

6. Description, procedure code, and the fee of each service performed.

7. Total cost of services performed.

8. State license number.

9. Specialty code.

Part 9: Best ways to know: What is included in dental insurance, what is not and why does this happen?

Dental, medical procedures are mainly used for two reasons.

1. For essential dental, medical procedure.

2. For cosmetic dental, medical procedure.

1. For essential dental, medical procedure: This is a necessary procedure, in the absence of which a person’s life can be lost or his life can be full of difficulties.  

2. For cosmetic dental, medical procedure: This procedure is used by a person to enhance the beauty of his teeth; this medical procedure does not come under the category of essential dental, medical procedure.

Part 10: Practical best tips: How to file a complaint against a dental insurance company? When doesn’t the insurance company provide you fair compensation?

If you have purchased a dental insurance policy and it is legally valid and meets all the required legal parameters.

Now, if any insurance company refuses to provide you compensation, then you can complain to the concerned department by following the things mentioned below.

1. You talk to the insurance company’s representative and ask them why you are not being indemnified when your insurance policy is legally valid.

2. You ask the representative whether the reason for not providing the compensation is not fulfilling any necessary document.

3. Now, if it seems to you that the insurance company does not want to compensate you, then by following the things mentioned below, file their complaint.

4. You write a letter to the insurance company for non-receipt of compensation. If you don’t get a positive answer, take further action.

5. Report your problem to a third party, such as the Ombudsman, and request their help with this.

6. You must file a complaint with your state’s insurance department, which regulates insurance activity and insurer compliance with state laws and regulations.

7. If your complaint is not resolved by all the points mentioned above, in such a situation, you should seek justice for yourself through the court.

Part 11: Frequently Ask Questions about dental insurance commonly asked by the people.