What is Dental Insurance in Texas?
Dental insurance provides coverage to help reduce the cost of dental bills. In exchange for a monthly premium (or fee), you’ll have access to discounted dental services.
The type of plan you choose and level of coverage determines your actual amount of dental benefits. Just like health insurance, you’ll often have to pay a deductible. A deductible is the cost of dental services you’re required to cover before your dental benefits kick in.
The biggest difference between dental and health insurance is the maximum benefit limits. You often only have to pay up to a certain amount out of pocket for health insurance. Once you reach this limit, your health insurance pays for any other medical costs you may have over the year.
Dental insurance works almost the opposite. Most dental plans provide a coverage limit. Once the insurance company pays for a certain dollar amount of dental treatments, you pay any additional treatments out of pocket.
Dental Plan Network Options:
Dental preferred provider organization (PPO)
Dental health maintenance organization (DHMO)
Dental discount plans
Each type of insurance or plan has different benefits and drawbacks. Understand a few key dental insurance terms before you take a closer look at the types of dental coverage available.
Dental Preferred Provider Organization (PPO) Network Option:
Dental preferred provider organization plans offer a dentist network where you can receive discounted dental services from in-network dentists. You usually pay a deductible, coinsurance or copay and your insurance covers the remaining balance. Your benefits may be reduced if you choose to use a dentist out of the network.
Let’s say you have a PPO plan with a $50 copayment for a service with an in-network dentist. The same service has a $75 copay if you use an out-of-network dentist.
Most PPO dental plans also have a benefit maximum. Once you reach the maximum amount of insurance coverage each year, you’ll have to pay out-of-pocket for additional dental services.
- You can visit any dentist you want.
You won’t have to choose a primary dentist and you don’t need a referral to see a specialist like an oral surgeon.
- You can incur deep savings by using an in-network dentist.
- In-network claims are automatically submitted to your insurance company.
- They’re pricier than other options.
- You’ll have to pay more for dental treatments if you go outside your dentist network.
- You’ll get an annual maximum benefit.
- There’s a longer waiting period than other plan types.
Dental Health Maintenance Organization (DHMO) Network Option:
You’ll choose 1 network dentist when you start a DHMO plan, which is sometimes called a prepaid dental plan. This dentist is your primary provider. Each network dentist receives a monthly fee for each plan member.
This set monthly payment to dentists allows you to get common dental services for little to no cost. There are usually no benefit maximums or deductible for DHMO plans.
You may have to pay the full cost of services out of pocket if you choose a dentist other than your primary provider. You also usually need to obtain a referral from your primary provider before getting specialty dental work.
- You’ll get a set copay with no deductible or benefit maximum.
- These offer the lowest plan premiums.
- There are short waiting periods and some plans have no waiting period.
- You’re limited to which dentists you can visit.
- You may have to pay the full cost of treatment outside of the network.
Dental Discount Plans Network Option:
Technically, dental discount plans are not insurance. They are actually discount plans for certain dental services. There is usually a dentist network. You are given a discount card to present at an in-network dentist.
This discount card gives you immediate savings on dental treatments. Savings may be a fixed dollar amount or percentage of regular service costs. You pay a monthly or annual fee to be on the discount plan.
For example, let’s say you pay $100 a year for a dental discount plan. Routine cleanings at an in-network dentist are $100 full price. Your discount plan gives you 20% off, so you only have to pay $80 for the service.
- There’s no waiting period.
- You don’t have a deductible, copayments or coinsurance — you get a predetermined discount on certain services.
- There’s no maximum benefit.
- You don’t have to complete claims paperwork.
- You won’t receive free preventive care, unlike many dental insurance plans.
- There are higher-cost services, like wisdom tooth extraction, which may only offer a small discount.
- You can’t combine vision and dental insurance for a discount.
What Does Dental Insurance in Texas Cover?
The services covered by your dental insurance plan will depend on the company and plan you choose. Coverage varies between plans and providers but most dental insurance plans offer a 100-80-50 coverage structure.
The number represents the percentage of service that is covered:
- 100: Covers 100% of preventive dental services like routine exams or yearly cleanings.
- 80: Covers 80% of routine dental work, including root canals or fillings.
- 50: Covers 50% of major dental procedures — including crowns or implants.
What Does Dental Insurance in Texas Not Cover?
Just like the services that are covered by dental insurance, the exclusions differ between plans. However, most dental insurance plans do not offer coverage for the following services:
- Cosmetic dentistry, such as teeth whitening
- Orthodontia, like braces
- Preexisting conditions
There are a number of reliable insurance companies that provide dental insurance in Texas. We analyzed different dental insurance providers to take the guesswork out of your search. It’s important to do your own research so you find the best dental insurance for you.
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