Your General Dentist in Peoria Breaks Down Dental Coverage Information


Your dentist in Peoria, IL knows how overwhelming insurance policies can be, so we promise to work with our patients when it comes to billing and payments. If you’re getting insurance for the first time, you’ll have a lot of plans to choose from. The options may seem staggering, but there are easy ways to find the right coverage you need.


Choosing an Employer’s Plan or the Insurance Marketplace

Most Americans with dental insurance receive coverage from an employer, rather than buying insurance individually. However, if your insurance does not offer dental coverage there are options available in the insurance marketplaces set up by the Affordable Care Act. The marketplace mostly takes place online and there are websites that cater to each state that let you shop for plans. You may be able to dental coverage as a part of your overall health plan or you can choose to get dental coverage as a separate, stand-alone plan.


Keep in mind that the health reform law treats adults and children differently when it comes to dental coverage. According to the law, coverage for children is considered an essential health benefit, which means that insurance plans in the marketplace must offer it for children, but health insurance plans do not have to offer dental care for adults.


Types of Plans

HMO is the least expensive kind of dental coverage. In dental HMO, you get all your dental care from dentists in your plan’s network. IF you go out of network, you will have to pay the full cost of the care you receive.


PPO is what most employer-provided dental insurance comes through. These plans usually have slightly higher monthly fees known as premiums compared with HMO. Like HMO, PPO also has a preferred network of providers, but the network is usually bigger than the network in an HMO. You’ll still get some coverage if you go out of network, but you will have to pay more of the total cost than if you used a dentist within the PPO’s network.


Dental discount plans are similar to a Costco or Sam’s Club, but of dentistry. You’ll pay a monthly fee, typically around ten to fifteen dollars, and in return you’ll get discounts on dental care.


Dental indemnity plans are options with higher premiums and co-pays than either HMOs or PPOs. A co-pay is a set fee that you pay each time you see a dentist. The advantage of this plan is that they allow you to choose any dentist you want.


The Services Your Plan Will Cover

Most dental plans divide their coverage into four general classes of service. Each covers different types of care. A Class I service includes diagnostic and preventive care like cleanings, checkups, and X-rays. A Class II service includes basic restorative care such as fillings and root canals. A Class III service includes major restorative care such as crowns and bridges, while a class IV service includes orthodontia. Not all plans have this coverage available. The ones that do, usually have a separate lifetime maximum and may only cover braces up until a certain age such as under 19.


Depending on your type of plan, your coverage for these services will vary. For example, with a dental PPO coverage is typically a certain percentage. They will cover 100 percent of Class I services, 80 percent of Class II services, and 50 percent of Class III services. There is usually a fifty dollar deductible for these services as well. With Dental HMOs, you’ll usually have a specific copayment for each type of service rather than a percentage. Generally, for a dental exam Class I service you’ll pay a ten dollar copay and then for a filling Class II service you’ll pay a twenty dollar copay.


Your Dentist in Peoria, IL hopes that all of our patients experience the best service, even beyond our office doors. If you have questions or need assistance with finding out about payment options and insurance carriers who have us in their network, please call us at (309) 688-7321.



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