Preventive care helps us maintain the health of our mouths and avoid tooth decay, tooth loss, and other harmful problems.
Visiting the dentist at least once (preferably twice) per year helps your dentist detect cavities early, which can help stop them from getting worse. This reduces your chance of needing complex and costly dental work down the road. It also helps your dentist see any changes in your oral health when you return for your next appointment!
Did you know your dental benefits are based around preventive care? When you understand what preventive care is, you can better understand how to put your dental benefits to use.
Better understand your dental benefits by getting familiar with how they work:
How Preventive Care Works with Your Dental Coverage
Because we believe in the importance of dental care, Delta Dental plans usually cover 100 percent of routine preventive, and diagnostic care. This includes procedures like cleanings, exams, and X-rays.
If your dentist finds tooth decay or signs of a cavity, fillings, root canals, and tooth extractions are usually covered up to 80 percent, depending on your coverage. That means your dental insurance carrier will pay the majority of the cost, leaving you with 20 percent to pay. Click here to learn more about your dental plan’s coverage.
*Be aware that a deductible — the amount you pay before your dental insurance kicks in — may apply to these services. Your coverage will depend on your specific plan details.
What is a Dental Claim?
A dental claim is created when you get a dental procedure done and it outlines the procedures that were performed. This document is sent to your dental insurance carrier, who will then review the claim against your oral health history and ensure your benefits are applied correctly to the procedures.
What is a Deductible?
The amount of money a member agrees to pay before your dental insurance carrier starts to pick up the tab is called your deductible. You must pay for your dental care until your plan’s deductible is met. However, you only have to meet your deductible once in a plan year.
Deductibles usually don’t apply to preventive care such as regular exams, X-rays, and cleanings, which are often covered 100 percent, even if your deductible hasn’t been met yet. A regular dental exam often includes a thorough cleaning of the teeth, a screening for oral cancer, and a general exam to see how healthy your mouth is.
Sign in to your member account or review your member ID card to see what your deductible is.
What is a Copay? What is Coinsurance?
Coinsurance and copays are how you share the cost. A copay is a fixed dollar amount, while coinsurance is usually written as a percentage.
With a copay, you’ll always pay the fixed amount (say, $20) no matter how much the total cost of your appointment was. Coinsurance will always be a percent of the total cost from the dentist.
What is a Dental Plan’s Annual Maximum?
This refers to the maximum amount of money your plan will pay for dental services in your plan year. If a member’s plan is based on the calendar year, then the timeframe for their annual maximum is from January to December.
If you reach your annual maximum in August, you will have to pay for dental procedures without sharing the cost with Delta Dental until your plan year starts over the following January.
What is a Premium?
This is the fee paid for your dental plan, which is usually a monthly charge. If your benefits are given to you through your employer, they likely pay either part of or all of the dental insurance premium.
Broaden your understanding of dental benefits basics with our Dental Insurance 101 post.