Understanding Your Dental Benefits

If you’re like most people, you probably don’t pay much attention to your dental plan. But it’s important for you to read and understand it, because the insurance benefit contract your employer chose may affect the dental treatment options your insurance will pay for.

How Your Dentist’s Fees Are Determined

Your dentist’s fees are based on the treatment and time it took to complete, as well as some office costs, such as staff and equipment. The fee charged by your dentist may not be the same as the maximum fee allowed by your dental insurance plan.

Plan Maximums

The insurance carrier may set limits on the maximum they are willing to pay for a procedure. These limits may or may not reflect the actual costs of dental treatment. Insurance companies often use their own standards to determine the maximum fee they will pay. If the plan’s limits are very low, you may end up paying a greater amount out-of-pocket.

Your dental benefits plan may also have annual and/or lifetime maximums. Be sure you are aware of the maximum limits for your particular plan, as this will affect your out-of-pocket expenses too.

Least Expensive Alternative Treatment

Your dental plan may limit the types of treatment it will pay for. While your dentist provides a recommendation based on the best type of dental treatment, your insurance company may pay for only a less expensive “alternative” treatment. In this case, you have to choose between a higher out-of-pocket cost or an alternative treatment that may not meet your dental needs.


Some insurance plans require that you get dental treatment from a dentist who is a member of their network of preferred providers. If you choose to seek treatment from a dentist who is “out-of-network,” your dental treatment may not be covered by your insurance plan. When switching dental plans, make sure your plan will allow you to keep seeing your own dentist.

Have More Questions?

Talk with your employer about the dental plan they offer. Often this is the best place to get answers about your specific coverage. However, don’t hesitate to talk with your dentist’s office if you have questions or need help making a choice when it comes to your dental treatment and coverage options. Your oral health is an essential part of your overall health!