Flexible, Affordable Dental Insurance You Can Understand
Oral Care and Dental Insurance
Terms and Definitions
Dental insurance policies are filled with technical terms relating to your plan, dental services and procedures covered. To help you unravel the complexity of your plan, we’ve provided a glossary defining all the common dental insurance terms, as well as terms related to dental services and oral care. From “Annual Maximum” to “Periodontics,” learn the terms you need to know in order to understand your insurance policy.
Have a Question?
Contact our Wisconsin dental plan providers for more help understanding your dental insurance plan.
Annual* Maximum (Benefit)
Also known as your Annual Plan Maximum, this may be based on a 12-month benefit year or based on the calendar year. The average dental plan often offers between $1000 and $1500 per year, per person, payable on covered services. However, not all services are covered equally by the insurance plan.
*The majority of Momentum Insurance Plans run on a 12-month benefit year and not on a calendar year.
Basic Restorative Services
Basic restorative services generally include treatments and procedures that aren’t complex.
These services typically include:
- Fillings (amalgam, composite)
- Emergency pain relief
- Periodontal maintenance
- Simple extractions
- Some endodontic procedures
*This may vary by policy.
An orthodontic treatment to correct “bad bites” and to straighten crowded or crooked teeth. Combined with other orthodontic procedures, braces can also be used to help shape jaws if they don’t meet properly or to widen the palate.
There are several types of braces options available. When it comes to braces and orthodontics, it is important to know what your insurance covers and how that coverage differs for children, teens, and adults.
A dental bridge fills the gap created by a missing tooth. Bridges can restore your smile, help you bite properly, or keep remaining natural teeth in place.
There are 3 main types of dental bridges: Traditional, Cantilever, and Maryland bonded.
A traditional bridge is made up of two or more crowns that surround the gap and the false tooth (or Pontic) that is placed in the gap. These are the most common types of bridges and are either made of porcelain fused to metal or ceramics.
Cantilever bridges aren’t very common anymore, but were used when there was an adjacent tooth on only one side of the missing tooth. It isn’t recommended for the back of the mouth, as it can put too much strain on other surrounding teeth.
Maryland bonded bridges are also known as resin-bonded or Maryland bridges. They are either made of porcelain, porcelain fused to metal, or plastic teeth and gums structured with metal or porcelain framework.
The cost of dental bridges depends on several factors:
- Potential need for additional procedures (such as fillings or root canals) in one or two of the adjoining teeth
- Dentist and lab technician’s technique
- Dentist’s location
- Type of material used for the bridge
Dentists recommend everyone should routinely clean their own teeth, which includes brushing and flossing twice a day. Even if you think your regimen is pretty effective, regular cleanings done by a professional dental hygienist are an absolute must. This involves the removal of dental plaque to avoid cavities, gingivitis, and periodontal disease.
You should visit your dentist 2x a year for professional teeth cleanings. Dental cleanings are typically considered preventive services and often completely covered by your insurance plans. Plans may vary, so you should always understand your coverage before receiving any dental treatment or service.
Regular professional dental cleanings are important for everyone to maintain healthy and strong teeth.
Coinsurance is the arrangement between the insured individual and the insurance company where the insured is expected to pay a percentage of expenses.
What’s the difference between copay and coinsurance?
Copay and coinsurance are similar, but copay requires a flat-rate fee instead of a percentage for payment. Coinsurance only applies after the deductible is met. The deductible varies according to your dental insurance plan. Check your plan for more details.
Cosmetic dentistry includes certain dental procedures that result in a more attractive smile and better-looking teeth. The need for cosmetic dentistry is strictly for outward appearance – nothing medically necessary. Cosmetic services include: teeth whitening and bleaching, veneers, teeth contouring and reshaping, and more. Cosmetic services are often excluded from insurance coverage.
*Insurance coverage varies by each policy.
This term describes the overall scope of your dental insurance and what treatments are covered, what dentists you can go to, and what copays, deductibles and maximum benefits are provided. Most coverages are based on the policy year which may not coincide with the calendar year.
Coverage also refers to how much the insurance provider will pay. For instance, 50% coverage on a $100 procedure would cost you $50 out-of-pocket.
Coverage varies depending on your plan, and typically dictates premium costs (higher coverage generally results in higher premiums). Most dental plans have a benefit year maximum, this is the maximum cost the plan will cover in a given 12-month period. This number varies depending on the type of plan chosen and ultimately affects the overall coverage.
A covered dependent includes the spouse and children of the policy holder. Dependent children are usually eligible for coverage until they turn 26 years old.
Eligible children include:
- Biological children
- Foster children
- Children under your legal guardianship
- Children legally adopted by you or your spouse
Children can join or remain on a parent’s plan even if they are:
- Not living with their parents
- Attending school
- Not claimed as a dependent on their parent’s tax return
- Eligible to enroll in their employer’s plan
Consult your dental insurance plan for more details on who is covered.
Crowns are a type of dental restoration that caps or covers a tooth. They are typically made from gold, ceramics, or porcelain fused to metal.
Crowns are used to protect or restore a weakened or broken tooth, and can even help strengthen a tooth with a large filling when there isn’t enough tooth remaining to hold the filling structure. Crowns can also be used for:
- Cosmetic purposes
- Attaching bridges
- Covering discolored or oddly-shaped teeth
Crowns are made from various materials, including:
- Stainless steel
What’s the difference between temporary and permanent crowns?
Temporary crowns are made from an acrylic-based or stainless steel material. They are used as a short-term solution until replaced by a permanent crown. The temporary crown is created right in your dentist’s office, whereas a permanent crown is typically made in a lab.
The deductible is the amount you owe for covered dental services before your dental insurance plan begins to pay. For example, if your deductible is $50, your plan won’t begin to pay until you have already paid $50 for covered services. After your deductible is met, you will typically pay a copay or coinsurance – insurance covers the rest until you reach your benefit maximum.
Most dental plans have a specific dollar deductible. Some dental plans will waive the deductible on preventive and diagnostic services.
Knowing the ins and outs of your insurance policy is important, including your deductible amount and coverage. Contact our dental insurance professionals for more details.
A denture is a prosthetic device used to replace missing teeth. There are two types of dentures: complete and partial.
Complete dentures are needed when all of the natural teeth have been removed. They can be either conventional or immediate. Conventional dentures are ready for placement in about 8-12 weeks after teeth removal. Immediate dentures are placed at the time teeth are removed. Discuss the pros and cons of each with your dentist.
Partial dentures are a removable denture or bridge that is attached to a gum-colored base. This type of denture is only needed if some of the natural teeth are missing. Partial dentures also prevent the surrounding natural teeth from shifting position.
Most dental insurance providers cover some of a denture’s cost. Contact your insurance company to find out the specifics of what may be covered.
Discount Dental Plans
A discount dental plan is designed for groups, families, and individuals looking to save money on dental care, which might include checkups, cleanings, and more. It is not a dental insurance policy like you would get with Momentum Insurance. A dental discount plan is like a membership program, you pay an annual fee to join and you get access to discounted services at participating dentists.
Discount dental plans are not for everyone. While some people prefer them for their simplicity and low price point, they miss out on the coverage provided by an insurance policy. Discounts can vary from place to place, and might change with time. An insurance policy’s predetermined percentage is a more secure way to ensure coverage.
While discount dental plans cover a portion of the cost, an insurance policy may cover the entirety of the procedure. A discount dental plan designed to save you money might actually cost you more in the long run compared to a more affordable insurance policy from Momentum Insurance Plans, Inc.
Employer sponsored insurance is paid for by a business on an employee’s behalf, either partially or entirely. This type of insurance is usually part of an employee benefits package.
Since employer-provided dental plans are not mandatory, they are often not offered in order to save money. Unfortunately, they are seen as added expense for the company, but this is not the case. Employer sponsored insurance through Momentum Plans generally has much lower rates, making it more affordable for businesses to offer these additional benefits to their employees. By offering dental coverage, companies retain more workers who enjoy their benefits package.
Exclusions and limitations are the dental services and procedures that are not covered by dental insurance. All dental insurance plans can differ in exclusions. Even some pre-existing conditions are excluded from coverage. See Momentum’s Exclusions policy.
Exclusions are also used for certain risks that usually can be controlled by the policyholder. There are several factors that determine exclusions, including:
- Damage from lack of regular maintenance
- Issues that result from illegal or criminal acts
- Damage caused by intentional actions
A fee schedule is the maximum fee allowed by insurance for a service and is agreed upon by participating dental providers.
A filling is a type of material that fills in a part of a tooth structure that has been damaged from decay or external trauma.
Fillings are made from a variety of materials, including:
- Silver Amalgam
- Composite Resin
Your dentist can help determine which filling material makes the most sense for you. The out-of-pocket cost of a filling depends on the material used and your insurance plan.
Flexible Spending Account (FSA)
A Flexible Spending Account (FSA), also known as a flexible spending arrangement, is an employee reimbursement program that employers offer to eligible employees. The account can be used to pay for copay, deductibles, drugs, and other healthcare costs. An FSA is primary funded with employee salary deductions and reimbursed back to the employee for health care, while existing as a nontaxable benefit.
Group Dental Coverage
Group dental coverage is reserved for a specific group of people, as opposed to individual coverage. Group coverage is most often offered by an employer.
What are the benefits of having group dental insurance?
- Employers most often enjoy tax breaks and incentives
- Business owners can generally deduct 100% of the premiums they pay
- Payroll taxes may be reduced
- Makes preventive dental care more affordable
There are different types of group coverage offered by Momentum Plans that let businesses create custom coverage based on what their workers need.
Guards and Appliances
Guards and appliances are removable dental devices used in preventive care to protect teeth from damage. Mouth guards and appliances will be custom-fitted by your dentist for optimal comfort.
There are several kinds of guards that assist with different issues. Discuss guards and appliances with your dentist to see if there’s a good solution for you.
Certain appliances may be excluded from dental plan coverage, but may be covered by medical insurance instead.
Periodontal disease is a leading cause of tooth loss and may be associated with other chronic diseases including diabetes and heart disease.
Types of gum disease:
Gingivitis is the mildest form of periodontal disease, which can caused by inadequate home care. The disease can also be attributed to factors like diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medications.
Signs of gingivitis include the gums becoming red, swollen, and bleeding easily. Gingivitis is reversible with professional treatment and good oral hygiene.
Periodontitis is basically untreated gingivitis. Over time, plaque can spread and grow below the gum line. The gums then separate from the teeth, forming pockets between the teeth and the gums. These pockets become infected, deepen, and eventually destroy the bone. The teeth can become loose and may have to be removed eventually.
A dental implant is a replacement for the root of a tooth. Dental implants are secured in the jawbone and are not visible once surgically placed. They are used to secure implant-supported crowns, bridgework, or dentures by a variety of means.
Dental implants are typically made of titanium, which is lightweight, strong, and biocompatible (won’t be rejected by the body). They also have the highest success rate of any implanted surgical device.
There are two types of safe dental implants:
Endosteal implants are surgically implanted into the jawbone. A second surgery follows, involving artificial teeth being individually attached to the post.
Subperiosteal implants are an entire metal frame that is fitted onto the jawbone below the gum tissue.
An in-network provider is a dentist that has a contract with your insurance company and can provide dental care to those policyholders. The insurance company and dentist agree to a fee schedule which leads to patients paying less for using a dental provider in their insurance plan’s network.
Lifetime (Benefit) Maximum
Some dental services, such as orthodontics (braces), do not have a benefit year maximum but instead have a lifetime cap on benefits.
Otherwise known as exclusions, this refers to what is not covered by dental insurance. All dental insurance plans can be different in this regard. Examples of coverage limitations include: pre-existing conditions, cosmetic surgery, non-traditional treatments, and limits on patient age or procedure frequency.
Momentum Gold Dental Insurance
The Momentum Gold Plan provides 80% coverage for all covered diagnostic and preventive dental services, which include exams, cleanings, bitewings, x-rays, sealants, and more. The plan also provides 60% coverage of covered basic restorative services, which includes fillings and simple extractions.
Other services that are 50% covered under this policy include:
- Emergency treatment to relieve pain
- Root canal therapy
The deductible for the Gold Dental Insurance Plan is $50 per individual and $150 per family. The annual maximum benefit of this plan is $1,200 dollars per person, per benefit year.
*Implant-related procedures and orthodontics are not covered.
Momentum Platinum Dental Insurance
The Momentum Platinum Plan provides 100% coverage (deductible waved) for all covered diagnostic and preventive dental services. The plan also covers 75% of basic restorative services, which includes fillings, sealants, and crowns, and 50% of other dental services. The deductible for the Platinum Plan is $50 per individual and $150 per family. The annual maximum benefit of this plan is $1,200 dollars per person, per benefit year.
*Implant-related procedures and orthodontics are not covered.
A network is a group of providers (in this case, dentists), that have agreed to provide dental services to the insurance plan’s members at a discount. Your cost to use network providers is usually less than using non-network providers.
Non-network providers cost more for a number of reasons. The provider is not bound to the price set by your insurer and your plan might require that you pay higher co-pays or deductibles, or even an out of network fee. Sometimes your plan won’t cover out-of-network care at all.
Orthodontics is the study and treatment of misaligned jaws and teeth. Orthodontists have specialty training in diagnosing, correcting, and preventing crooked teeth, overbites, and underbites that are caused by malpositioned jaws. Orthodontic treatments are available for children and adults, but it is recommended that patients have orthodontic services at a younger age. Orthodontics isn’t limited to just braces it can also include Invisalign, retainers, headgear and rapid palate expanders, and many more appliances that will realign the teeth and jaws.
Dental benefit terms including out-of-network & in-network providers can be confusing when reviewing your dental insurance plan. Understanding the difference of these two terms is very important for members of all ages as it can determine what out-of-pocket costs (if any) will be paid either before or after treatment. Out-of-network providers are not listed on the insurance plan and since they are not contracted with an insurance company, dental care treatment and services may not be covered. The patient may have to pay higher amounts for these services and there may not be reimbursement from the insurance company. If a patient has treatment at a dental clinic location or provider that isn’t in-network the patient could be responsible to pay the full amount of the services.
Pediatric dentistry focuses on children’s oral health. Pediatric dentists treat children starting at infancy and continue care for their dental health through their teenage years. Kids get their first teeth around the age of 6 months old. Children keep this first set until the age of 6 or 7 when they begin to lose their baby teeth and their second set of teeth (permanent) replace the first set. According to the American Academy of Pediatric Dentistry, in order to prevent dental problems, your child should see a pediatric dentist when the first tooth appears, or no later than his/her first birthday.
Periodontics is the study of the supporting and surrounding structures of teeth, and the diseases and conditions that affect them. A Periodontist is a person who practices this special form of dentistry.
Plaque is a bacterial biofilm that naturally forms on teeth and assists in cavity development. Regular brushing and flossing helps reduce plaque buildup, and results in a more enjoyable dental cleaning visit. Though some plaque cannot be removed by regular brushing and flossing, bi-annual teeth cleanings will thoroughly remove the remaining plaque.
The specific rate you pay for active dental coverage. Generally, this is paid monthly. In order to maintain your insurance coverage, you must pay your premium every month.
If you miss a payment, coverage may be terminated with written notice. Premiums are different from deductibles or co-pays because premiums must be paid in order to receive any coverage at all.
Momentum’s Easy Premiums Help You Stay Covered
Momentum makes paying your premiums easy! Set up recurring payments when you enroll. Momentum has a number of plans with low premiums available for individuals, families, businesses, and more.
A root canal, is a procedure that removes bacteria and infected areas inside of a tooth. This procedure is often performed by an endodontist, but some dentists offer root canal treatments which are also known as endodontic therapy. After the inflammation and infection is removed, the tooth is disinfected and cleaned, then it is filled and sealed. A root canal is often thought of as a painful procedure, but your endodontist is skilled in making the procedure comfortable to preserve your natural teeth.
Several benefits to having a root canal include:
- No change to bite
- Chewing comfortably
- Natural tooth is saved
- Prevents wear or strain on the jaw and teeth
A sealant is a thin, plastic coating placed in the occlusal pits and fissures (the chewing surfaces) of the tooth to prevent decay. The sealant acts as a protective shield of the tooth’s enamel. The molars, or teeth at the back of the mouth, are the typical target for sealant treatment.
Veneers are ultra-thin shells of porcelain or a composite resin material that are bonded to the front of teeth. This can significantly improve the appearance of the front teeth, as well as protect them from damage. Veneers mask discolorations, hides chips on the edge of the tooth, closes gaps, brightens teeth, and improves the overall smile.
Veneers are often excluded from dental coverage and considered cosmetic.
Voluntary Group Coverage
Voluntary group coverage allows employees to opt in or out of coverage. By allowing employees the opportunity to opt out, they are able to save on health care expenses. Additionally, the employees pay the premiums, sometimes from a payroll deduction.
Regular checkups and cleanings lead to better oral health and overall well-being. Providing some type of dental insurance makes employees more willing to seek preventive care. Voluntary plans provide custom options to cover everything from annual exams to x-rays and surgical procedures.
Since the plan is voluntary, employees cover all the premium costs. The group rate is lower than if each applied for an individual insurance plan. Voluntary dental plans may also include a waiting period to prevent abuse of the system.
A set amount of time a person must be a member of a dental insurance plan before they are eligible to receive the benefits from their plan.
Dental insurance waiting periods are specific to your plan and can vary from service to service. Some plans have no waiting period for preventive and diagnostic care, including teeth cleanings or emergency pain relief procedures. If you need restorative dental services, these same plans might have 6-12 month waiting periods. Waiting periods are a large deciding factor when it comes to choosing the right dental plan. Getting dental insurance before dental problems arise ensures you have coverage when you need it without having to wait.
Why is there a waiting period?
Waiting periods are used by insurance providers to ensure customers don’t buy dental insurance right before they want coverage on a procedure, and then drop the plan afterwards. If you require a major procedure before the waiting period is up, talk to your dentist about payment options.
No Waiting Periods for Preventive and Diagnostic Procedures
Momentum Insurance Plans, Inc. understands how important preventive dental care can be, which is why we have no waiting periods for preventive procedures, even on our simplest plan!
Plans like the Protect Plan have no waiting period on any services covered; while comprehensive plans like the Platinum Plan don’t have a waiting period on preventive and diagnostic services, and only have a 6-month waiting period on fillings. Momentum provides affordable and comprehensive coverage on a network you know and love with minimal waiting periods.