Dental Insurance FAQs

By Susan Braden

With today’s declining economy, many Americans are considering obtaining coverage to help save on out-of-pocket expenses at their dentist. However, there are many questions people want to know the answers to before they invest in dental insurance.

What Are the Different Types of Plans Available?

There are many different types of insurance plans, each with their pros and cons. Some of the different choices include:

• Dental HMO: This plan assigns certain dentists for intervals of treatment. These dentists are in a contract which states that they will be paid a certain amount even if no treatment was required.


• Dental Care Service Plan: This uses a non-profit organization of dentists to provide procedures at set fees.


• Direct Reimbursement Plan: This allows employees to be directly reimbursed by employers for any service they receive.


• Indemnity Plan: Indemnity plans are fee-for-service. They have limitations and co-payment options, meaning you will pay a flat fee for the visit, but there is a yearly limit on how much you can spend. However, indemnity plans do allow you to choose your own dentist.


• Preferred Provider Organization: PPO plans are limited to a specific group of dentists that are available to provide lower prices for oral care.

If none of these coverage options are affordable or practical for you, you may want to consider a dental discount plan, an affordable alternative to insurance.

What Does Dental Insurance Cover?

Different plans cover a different amount of procedures. If you are investigating an insurance, become familiar with the plan so you know what is covered and how. For example, if you need a resin-based composite (a white, “porcelain”) filling, weight the benefits of your plan for these fillings. Some companies will only reimburse the cost of a resin-based composite filling at a price equivalent to that of a metal amalgam filling so that you have to pay a larger % of the cost. The remaining balance would need to be paid out-of-pocket.

Typically, cosmetic procedures are not covered, although if you require veneers for restorative purposes, you may be able to file for reimbursement on a percentage of the costs. Also, some of the costs involved in the required prerequisites for a smile makeover, such as a root canal or orthodontics, may be covered.

What Are UCR Fees?

UCR stands for Usual, Customary, and Reasonable. It is the most common term that insurance companies use on their Explanation of Benefits. UCR fees are set by insurance providers and are based on the typical costs of different procedures. For example, if your procedure costs $120, your provider may have a UCR of $80. Therefore, you would have to pay the remaining $40 out-of-pocket.

Overall, dental insurance policies can be tricky to navigate. A dental discount plan is typically a simpler, more cost-efficient option to reduce the cost of procedures without breaking the bank.