The short answer: call the office and your plan
The fastest way to find a dentist that takes your insurance is to use two sources: your plan's online provider list and a phone call to the dentist's office. The list gives you names. The call confirms the truth, because lists can be out of date.
When you call, give the front desk your plan name, your member ID and the name on the card. Ask them to check your benefits before you book. A good office does this for you, and it takes a few minutes.
It is also worth knowing the difference between "accepts" and "in-network." Many offices will file a claim for you even if they are out of network, but you may pay more. Ask which one applies to you.
If you are shopping for a plan, not only a dentist, flip the order. Pick the dentist you want first, then ask which plans they take. A cheap plan is no bargain if none of the dentists near you accept it.
In-network vs. out-of-network, in plain words
Dental insurance companies make deals with dentists. A dentist who signs one is in-network, and agrees to set prices for covered services. Because of that, your share of the bill is usually lower.
An out-of-network dentist has no such deal. They can charge their regular fees, and your plan may pay a smaller share. Some plans cover out-of-network care at a lower rate, and some do not cover it at all.
The Humana guide to dental insurance sums it up well: members pay more when they go out of network, and they can face higher deductibles, copays and coinsurance. A deductible is what you pay before your plan pays. A copay is a flat fee per visit. Coinsurance is the percent you share after the deductible.
Ask your plan how much they pay a dentist for a crown, and how much your dentist charges for the same crown. When a dentist is in-network, that gap is usually written off. When a dentist is out of network, you may owe the difference. That gap is called balance billing, and it is the biggest source of surprise bills.
Three plan terms that surprise people
Before you rely on your plan, know these three terms:
These three numbers shape every treatment plan. If you are close to your annual maximum late in the year, you may want to schedule care before the plan resets. If you start a new job and a new plan, look at the waiting periods before you book a crown.
- Annual maximum: the most your plan pays in a year. Once you hit it, you pay everything else until the plan resets. One published plan summary lists $1,750 in network and $1,500 out of network, so the number can differ by network.
- Waiting period: the time you must wait before some care is covered. Cleanings and exams often start right away. Crowns, bridges and other major care can have a wait. One employer plan listed no wait for preventive and basic care and 12 months for major care.
- Coverage percent: many plans pay a higher share for cleanings and a lower share for fillings, crowns and implants. Ask what percent applies to the work you may need.
Questions to ask your plan and the dentist
Keep this list next to the phone:
Write down the name of the person you spoke to and the date. If a claim is later denied, that note helps you and the office sort it out.
- Is this dentist in my plan's network?
- What is my annual maximum, and how much have I used this year?
- Do I have a waiting period for crowns, bridges or other major work?
- What percent do you cover for fillings, crowns and implants?
- Can the dentist give me an estimate before treatment, and send it to you for pre-approval?
- Will you file the claim for me, or do I pay first and get reimbursed?
If you have Medicare
Medicare is where many people get confused. Original Medicare, which is Part A and Part B, does not cover routine dental care like cleanings, fillings, extractions, dentures or implants in most cases, according to Medicare.gov. It covers only narrow cases, such as certain dental work tied to a covered medical treatment.
Dental benefits usually come from a Medicare Advantage plan or a separate supplemental dental plan. Those benefits vary a lot: what is covered, how much the plan pays per year and which dentists are in the network.
The ADA notes that for dental benefits offered through a Medicare Advantage plan, a dentist generally does not have to be enrolled in Medicare to file a claim. Your plan's Evidence of Coverage document is the best source for what you will pay. Read it, or call the number on your card, and ask the dentist's office to confirm.
If you are choosing a Medicare plan this fall, look at the dental section of each plan before you enroll. Check the yearly limit, the percent paid for crowns and dentures, and whether your dentist is in the network. Open enrollment is the time to compare, and Medicare.gov has a plan finder to help.
Be careful with ads that promise full dental coverage for a tiny price. Read the limits. Plans with a low yearly cap may cover your cleanings but little else.
No insurance? You still have options
Many people in Miami do not have dental insurance. That does not mean you have to skip care. Ask the office about these options:
Do not let cost make you wait. Small problems tend to cost less than big ones. Cleveland Clinic says regular dental visits help find problems before they get worse. Asking for a payment plan early can keep a small problem small.
An ADA Health Policy Institute analysis found that about 1 in 5 working-age U.S. adults skip needed dental care in a year, often because of cost. If that is you, you are not alone, and offices are used to helping with it. Just ask.
- Payment plans or financing, so a large bill can be spread out
- An in-house membership or discount plan, if the office has one
- A written treatment plan with the most urgent care first
- Payment by credit card, debit card or mobile payment, whichever is easiest for you
Red flags and green flags when you call
A good insurance conversation sounds like this: "Let me check your benefits. I will call you back this afternoon with an estimate of your share." That is a green flag. It means the office is organized and respects your time.
Red flags include vague answers like "most plans pay most of it," a refusal to give an estimate in writing or pressure to start major treatment before you know what you will pay. If you hear those, keep calling.
Remember too that an estimate is not a promise. Insurers decide claims after treatment, and plans have limits. But an office that explains how the estimate works is an office you can trust.
Finally, keep your own file. Save your plan documents, your treatment estimates and your receipts in one folder on your phone. When your coverage questions come up, you will have the answers in one place.
Insurance and payment at Kendall Dental Associates
We accept most dental insurances and most Medicare supplemental plans, and financing is available. We take credit cards, debit cards and mobile payments. Because plans differ, please call us at 305-271-1421 with your plan name and member ID, and our team can help you understand what to expect before your visit.
We have served Kendall since 1973, at 8833 SW 107th Ave in the Kendall Mall. We are open Monday to Friday, 8:00 AM to 5:00 PM, with emergency care 24/7. Parking is free.
Free X-ray, exam and consultation. New Patient Special. New patients only.
The patient and any other person responsible for payment has the right to refuse to pay, cancel payment or be reimbursed for payment for any other service, examination or treatment that is performed as a result of and within 72 hours of responding to any advertisement for the free, discounted fee or reduced fee service, examination or treatment. D0191, C6182
Common questions
How do I find out if a dentist takes my insurance?
Check your plan's provider list, then call the dentist's office with your plan name and member ID. Ask them to verify your benefits.
What does in-network mean?
In-network means the dentist has agreed to set rates with your insurer. Your share is usually lower than at an out-of-network office.
Does Medicare cover dentists?
Original Medicare does not cover routine dental care in most cases. Some Medicare Advantage or supplemental plans do. Check your plan's documents.
What is an annual maximum?
It is the most your plan pays toward your care in a year. After that, you pay the rest until the plan resets.
What if I do not have insurance?
Ask about financing, payment plans and a written treatment plan with the most urgent care first.
This article is general information, not medical advice. Your dentist will confirm what is right for you at your exam. General information checked against: humana.com, ameritas.com, medicare.gov, ada.org, drbicuspid.com, my.clevelandclinic.org.