Does Insurance Usually Cover General Dentistry?

A: It really does depend on what type of insurance you have. Every patient typically has some form of insurance and so what we do, is we make sure to vet that insurance. We like to make sure we can let you know upfront what it’s going to cover.

Typically, the general averages these days cover most preventative such as an exam or cleanings. If it’s what’s called “minor” dentistry such as fillings and things like that it’s usually about 80% covered by insurance. Then, more complex dentistry like crowns and root canals is usually about 50/50.

Most insurance plans cap out between $1,000 to $2,000 each year, so it’s important for patients to know that. We work with each patient to help them determine what benefit they will receive.

Need A Dentist In Houston Under Your Insurance?

Dental insurance can be of much assistance to cover the costs of most dental procedures. If you end up needing expensive dental procedures it could end up being a lifesaver!

Over one-third of Americans have not visited a dentist in the last 12 months, according to the recent statistics. When patients come into our office after years without seeing a dentist in Houston, we ask why the gap? More often than not, the answer we receive is due to the cost of even basic dental care. These patients are usually not insured and are paying out of pocket, so naturally their costs will be higher. they cite financial issues as the reason.

Regardless of why you don’t see a dentist more often, dental care is essential to overall health. There are options to assist with the costs of visiting a dentist in Houston. The option that is best for you really depends on your individual needs and situation.

How Dental Insurance Works

Most dental plans use a pre-defined network of providers they work with exclusively. HMO and PPO are the two types of networks in dental insurance. In either one, using one of their providers will save you far more than going to a dentist of your choosing. In fact, you need to look at the difference between those two plans and a third option.

Visiting A Dentist In Houston With An HMO…

An HMO is the most restrictive of the three major types of dental insurance available. In this type of plan, you must use a dentist on the plan or it won’t be covered at all. HMOs, on the plus side do not have maximum benefit caps or require you to pay a percentage of the charges. Another benefit is that you have deductibles that are typically very low usually $25 or less.

That being said, you are very restricted in choosing one dentist or dental office for all of your dental care needs. Also, you will have copays, which is a set amount you pay every time you visit a dentist in Houston. This can be a deal-breaker if your plan doesn’t have a lot of providers in your area and you have to travel far.

With A PPO…

A PPO is still restrictive but not an all-or-nothing plan, there is some wiggle room albeit with a catch. If you use a network dentist you are covered at the stated coverage breakdown. However, you don’t have to use a network dentist. You can use any dentist you want, but you will pay more out of pocket.

PPO plans are the most common insurance but do have higher annual deductibles, though they aren’t astronomical at $50-$100 dollars. After that deductible is met, the plan will pay for the defined percentage of your dental care costs. Most PPOs cover 100% on preventative, 80% on minor procedures, and 50% on major procedures. Keep in mind, that unlike HMOs, a PPO plan does cap out how much they will pay in a year.

The Indemnity Option…

An indemnity plan is usually the least expensive plan with the most freedom as you can choose any dentist you want. But wait, there is a catch—you have to pay upfront and wait for reimbursement. The problem with that arises when you get into a $15,000 procedure. Not everyone has that kind of cash flow lying around. Also, indemnity plans have an annual cap as well so you might not be getting such a value after all.

Alternatives To Cover Costs At A Dentist In Houston

Sometimes, insurance just isn’t the right option for everyone, especially those with excellent oral health. They may just visit the dentist once a year as a good habit, and that could be the difference. However, for the rest, insurance may not be ideal but maybe some of these viable alternatives are.

Dental Discount Plans

Dental discount plans are completely different from HMO’s and PPO’s. That is because they are not insurance at all nor can they be used with insurance. They are also called dental savings programs and are an alternative to insurance.

They work more on a membership club model such as Costco or Sam’s but for dental care. Savings can vary wildly from program to program and some skeptics argue their worth. Nevertheless, many patients opt for these discount plans because of their low cost.

Here’s how they work: You pay an annual fee and some type of activation or enrollment fee. This fee is usually much less than insurance premiums. Programs range anywhere from $75- $250 a year per person for access to discounted rates.

Just like the insurance plans use a network of dentists, so it’s important to find a dentist you like in the network. Some discount plans have a large number of dentists participating and some have very few, you should research that beforehand.

When using the in-network dentist you receive a set discount on the services that are covered. However, keep in mind that the rate is still higher than if using insurance but less than if paying cash. It should be noted, that if you end up needing an expensive procedure, it can still be costly.

Paying Cash

Planning to pay cash for dental care is not something that is a practical option for many. However, if you are very healthy, maintain your teeth well, and have good genes, it may be. That being said, not everyone is that fortunate.

If you just need a dental cleaning twice a year or something, cash might honestly be the best avenue. It would be prudent though to put away money every pay period into a dental emergency fund. Something to fall back on if you end up needing extensive dental work suddenly.

Although rare, you may find a dentist in Houston that will work out a payment plan with you if you have earned their trust. Keep in mind though, it’s very rare to find that these days.

Financing

Financing the cost of dental care has become more and more popular over the years as lenders have seen the potential.

Lenders such as Care Credit specialize in lines of credit specifically for medical and dental procedures. Any dentist in Houston these days including Comprehensive Dental tends to partner with Care Credit.

It’s a great way to fix immediate dental issues before they worsen and cause even bigger problems. It doesn’t eat into your monthly budgeting and the payments are typically very manageable.

What’s Keeping You From Visiting Us?

Has it been more than a year since your last visit to us for a cleaning, routine exam or other issues? Are tight finances and a costly dental procedure looming over your head? You should never avoid the dentist, just call us to let us know the situation.

More often than not, we can point you in the right direction for an alternative to dental insurance or find ways to afford care.

No one should forego proper dental care due to a lack of funds, there are too many options for those in need.