So, you just signed up for dental insurance for the first time. This is an important step for keeping a healthy mouth and a bright smile! Before scheduling your first appointment with a dentist, though, it pays to learn more about your coverage. By getting familiar with insurance terminology and specific coverage details, you’ll have a better understanding of what your plan does and does not cover, how much you can expect to pay out of pocket, and how to make the most of your benefits.
Premium: The amount you’re required to pay your insurance company for dental coverage, usually on a monthly basis. Your employer may cover a portion of this cost.
Deductible: The amount you’re required to pay for covered dental services before your insurance will pay. For instance, your plan may come with a $50 deductible.* That means you owe $50 before your dental coverage kicks in. Once you meet that threshold, your deductible is met for the year.
If your plan also covers members of your family, you’ll have a family deductible. This is the amount your family must pay before benefits kick in. It’s important to note that every family member will still have an individual deductible. Coverage begins for individuals when either deductible is met.
Coinsurance: The percentage of a covered service you’re responsible for paying after you’ve paid for your deductible. In your plan details, you may see this as the percentage your dental insurance covers; the remaining percentage is your coinsurance. For example, let’s say your dentist charges $100 for a filling and your dental plan will cover 80%. Assuming your deductible has been met, you would just owe the remaining 20% — which is your coinsurance — for the procedure. You would pay $20 out of pocket, and your insurance would pay the other $80.
If your deductible has not been met, you would pay the first $50 and then insurance would kick in. From there, your insurance would pay 80% of the remaining $50 owed ($40) and you would pay the remaining $10, bringing your out-of-pocket total to $60.*
Annual maximum: The maximum amount of money your dental plan will pay for covered services per benefit year. You pay out of pocket for any dental services received after the maximum is met. The annual max amount will depend on your plan. With some plans, your annual max can “roll” or “carry” over to the following year if you use less than half of it.
Plan details and limits*
Now that you know a little more about the lingo, let’s dive a bit deeper. Dental plans have service classes, which dictate how much your insurance will cover for specific procedures. Here’s what they are and some examples of what they include:
- Diagnostic and preventative: Cleanings, exams, X-rays
- Basic: Fillings, root canals, tooth extractions
- Major: Implants, bridges, crowns
- Orthodontic: Braces
Dental plans may come with minor limitations. For example, some policies have age limits on procedures such as fluoride treatment and braces. Or, there could be a limit on how frequently you can receive certain services; many plans cover a maximum of two dental cleanings per year.
Plans can also come with waiting periods, which means members have to wait for a certain time period before their benefits kick in. Fortunately, standard Beam plans don’t have waiting periods.* Another common plan limitation is a missing tooth clause, which means insurance won’t cover the cost of the replacement procedure for a tooth that was extracted before the current coverage began. The good news: Beam doesn’t have one of those, either!
Beam offers PPO (preferred provider organization) plans, which means we have a network of dental providers who offer lower, contracted rates to be a part of the network. Visiting an in-network dentist is often advantageous because Beam may cover a higher percentage of the cost.* You can search for in-network dental providers with our Find a Dentist tool. However, if your preferred dental provider is out of network, you’ll still have strong coverage! Your out-of-pocket cost will depend on whether you have a MAC or UCR plan.
Still have questions about your dental plan? Check out our Beam Help Center!