Preventive, Basic and Major
There are 3 main categories your service or procedure from the dentist will fall under with dental insurance: Preventive, Basic & Major.
• Preventive: Exams, cleanings, sealants and fluoride treatments.
• Basic: Fillings, gum treatments
• Major: Implants, bridges, dentures, crowns, root canals and extractions
Some services may be found in either basic or major. It’s important to check for the specific service you’re looking for in the insurance plan you choose.
Coinsurance is the split cost of what the plan pays and what you pay.
From the main categories listed above (preventive, basic & major), we can look at an example for how coinsurance works.
Example: 100/50/25 (Preventive/Basic/Major)
From this, you would see that your preventive cleanings would be covered 100%, a filling would get 50% coverage and a root canal would get 25% coverage. For the root canal, the carrier pays 25% of the cost, and you pay 75%.
Some plans have graduating coinsurance that increase from year 1 to year 2 and so on up to a certain point.
Also, it’s important to note, insurance will only cover costs up to the annual max limit (see below).
The annual maximum is the amount of money the insurance carrier will pay out in claims each year. This money does not roll over.
An in-network provider is a dentist that has accepted a contractual agreement to lower costs per procedure. This is great for the consumer, because visiting an in-network provider brings savings on procedures which can average 20-50%.
Dentists can opt in or out each year, so it’s important you know if your dentist stays or leaves your network to continue receiving these additional savings.