It is the Beginning of the year and many people have questions about their current dental insurance plan as well as things to look for when choosing a plan.  Dental Insurance plans vary widely.  You should know how your plan is designed, since this can significantly affect the plan’s coverage and out-of-pocket expenses.  Keep in mind that dental insurance works a little differently than medical insurance.  First and foremost all dental plans are considered “supplemental.”  This means that regardless of deductibles and maximums they typically only cover a portion of each procedure.  Although the individual features of plans may differ, the most common design is "Usual, Customary, and Reasonable.” (UCR) programs usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called "customary," they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the "customary" fee level. 


To control costs, most dental insurance plans limit the amount of care you can receive in a given year. This is done by placing a dollar "cap" or limit on the amount of benefits you can receive, or by restricting the number or type of services that are covered. Some plans may totally exclude certain services or treatment to lower costs. It is always good to know specifically what services the plan covers and excludes.  Your dental provider can typically answer many of the questions you may have about your plan, but the only one that can answer all of your questions is carrier themselves.  There number should be on the back of your insurance card.


In reviewing and comparing dental insurance plans, consider the following when determining whether the coverage will satisfy your dental care needs:

        Does the plan give you the freedom to choose your own dentist or are you restricted to a panel of dentists selected by the insurance company? If restricted to a panel, is your dentist on this panel?

        Who controls treatment decisions -- you and your dentist or the dental plan? Some plans may require dentists to follow the "least expensive alternative treatment approach."

        Does the plan cover diagnostic, preventive, and emergency services? If so, to what extent?

        What routine treatment is covered by the plan? What share of the cost will be yours?

        What major dental care is covered by the plan? What percentage of these costs will you have to pay?

        What are the plan's limitations (a limit to the benefits for a procedure or the number of times a procedure will be covered) and exclusions (denied coverage for certain procedures)?

        Will the plan allow referrals to dental specialists? Will my dentist and I be able to choose the specialist?

        Can you see the dentist when you need to and schedule appointment times convenient for you?

        Who is eligible for coverage under the plan and when does coverage go into effect?