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What You Need to Know About Your New York Dental Insurance

New York dental insurance is essential. More people than ever are taking their dental health seriously and making it a priority. About 4 million people in the US wear braces and about 25% of those 4 million people are adults. Dental insurance can help to make dental care more affordable.

The Basics

Dental insurance in New York is like health insurance. There are about 110,400 insurance underwriters in the US, and about 42% work directly with insurance carriers. Underwriters are the ones that actually write the policies for both medical and dental insurance.

To secure dental insurance you pay a monthly premium and you get coverage, and just like health insurance, the type of insurance you choose will determine your premium costs, your co-pays, and your deductible.

Premium is how much you pay for the plan (typically on a monthly basis). A deductible is what you must pay before the coverage kicks in, and co-pay is your share of costs for the procedure. Low-income people may qualify for Medicaid which can cover dental care. Securing Medicaid requires that you file an application with the department of social services, provide proof of income, and have an interview with a caseworker.

Basic Coverages

All dental insurance offers different types of coverage. In most cases, the higher the premium, the more coverage. Almost every type of plan will cover the cost of exams, X-rays, and basic diagnostics without any out-of-pocket expense.

Diagnostic testing is often covered at 100%. It is usually generous or 100% coverage for preventive treatments like sealants on children’s teeth. Fillings are also usually covered at a very high rate. However, dental plans are not very generous when it comes to other types of treatments.

Medical Necessity

You should get familiar with the term medical necessity. Almost every dental insurance plan will make approval for service decisions based on a dental health need. In other words, if your dentist states you need the procedure to reduce the risk to your dental health, that carries weight with the dental insurance company.

Of course, there can be a discrepancy between what your dentist finds to be medically necessary and what your dental insurance in New York is willing to pay for. For example, you may think that a white composite filling is important to your smile health, but the insurance company may not find the need for a white composite filling. They may only cover silver fillings.

Usually at 50% or Lower Coverage

Some procedures like dental caps, veneers, and other cosmetic work is not covered at all, or if it is it is at a very low rate of coverage. Cosmetic dentistry like elective surgery in the medical field does not come with a medical necessity and insurance companies in New York and other states do not pay for those things.

For services like Invisalign braces, many of the dental plans will cover 50% of the costs. Invisalign has a very high rate of patient satisfaction. About 96% of patients report being satisfied with their results. Your insurance plan will likely pay for at least part of Invisalign treatment so you can join the ranks of highly satisfied patients.

Dentures and other prosthetic devices are covered at about 50% of the cost, it really depends on the type of policy you have. Implants, bridges, and other devices can all be covered under a good dental insurance plan.

Read The Fine Print

The best way to understand what your dental insurance covers and what it does not is to read the fine lines in your dental insurance plan. Your dentist’s office can be a great resource in figuring out what your plan will cover at what rate. Ask your dental office for help deciphering your dental insurance coverage.