Dental Insurance Options
Smile Dental Center is in-network with several major dental insurance providers in Shelton, CT. Call 203-712-7726 to learn more or schedule your first appointment!
Plans We Accept
We are participating providers for the following insurance plans:
- Anthem Blue Cross & Blue Shield
- Aetna PPO
- Delta Dental PPO/Premier
- Cigna PPO
- Guardian PPO
This means that we have a negotiated contract with each of these insurance companies for the designated type of plan. We are only allowed to charge you the negotiated fee, resulting in potentially substantial savings for you. However, we may be able to accept other insurance plans as well, though not at negotiated rates. Here’s a guide to the different types of dental insurance.
Types of Dental Insurance
There are three main types of dental insurance, each with its own pros and cons:
Dental HMO: Modeled after health HMOs, dental HMOs (health maintenance organizations) are the least expensive but the most restrictive. You must visit in-network providers, and you may need a referral from your primary dentist to see a specialist. Emergency care out of network may or may not be covered.
Dental PPO: Like a health PPO, a dental PPO (preferred provider organization) is like an HMO with more options. Your costs are lowest when you choose an in-network dentist, but out of network costs are covered at a lower rate. This is an excellent mid-range option that lets you choose an in-network primary dentist but retain the freedom to seek specialists or emergency care outside the network.
Dental Indemnity: Dental indemnity is the most expensive but most flexible option. You can visit any dentist you choose, as long as the dentist agrees to accept the insurance. Some dental indemnity plans even cover dental care in border towns in Canada and Mexico.
Types of Services
Dental care falls into three categories: preventive, basic, and major. Preventive care such as cleanings and exams may be covered at 80 percent or higher immediately, and at 100 percent in the second year and beyond.
Basic care, designed to save a tooth, may be covered right away, typically at 50 percent, or may have a 6 to 12 month waiting period. By year two, basic care may be covered at as much as 80 percent.
Major care, such as crowns, bridges, or dentures, may be covered immediately at around 25 percent, but most often has a 12 to 18 month waiting period. By year two, it may be covered at as high as 50 percent.
The Fine Print
Be sure to read the fine print in your contract. There may be exclusions and limitations that do not match your dentist’s recommendations. There is also an annual cap on the amount the insurance company will pay, which could be $3500 or more, but is more commonly $1000 to $1500. Orthodontic treatments may have their own annual and lifetime caps.
Direct Pay vs. Reimbursement
We accept assignment of benefits for the insurance plans with which we participate. This means that your out of pocket costs are limited to the portion your insurer does not cover. Many plans, though, particularly dental indemnity plans, require you to pay the full cost of treatment out of pocket and then wait for reimbursement.
Everyone’s needs are different, and an insurance plan that is perfect for one family may not work at all for another family. Individual dental insurance costs little more than employer-sponsored plans, so take the time to shop around and figure out what truly meets your needs and goals.
Call 203-712-7726 to learn more or schedule your first appointment!