®Patient guide
Dental insurance, explained
Where dental insurance came from, and the terms that decide what you pay. We'll check your benefits before treatment, so there are no surprises.
History
Why plans work the way they do
Most dental plans today still follow a design from the 1960s and 70s. That history explains why annual maximums feel low and why coverage is split into tiers.
- 1954
The first dental plan
One of the first dental benefit plans in the United States started in 1954 in Washington State, for members of the International Longshoremen's and Warehousemen's Union. It was negotiated as a workplace benefit, and employer-sponsored dental coverage grew from there.
- 1960s–70s
Insurance companies join in
Delta Dental expanded, and carriers such as Aetna, MetLife and Cigna entered the market. The familiar 100/80/50 coverage pattern and the $1,000 annual maximum date from this era. Many plans still use that same $1,000 maximum today.
- 1980s–2000s
PPO networks
Plans began contracting with dentists at set, discounted fees. Whether your dentist is in your plan's network now affects what you pay.
- Today
Still built on the 1970s design
Annual maximums have grown a little, with many plans at $1,500–$2,500, but the 100/80/50 pattern, deductibles and network rules work much as they did 50 years ago.
Key terms
Ten terms to know before your visit
- Premium
- What you or your employer pay each month to keep coverage active, whether or not you visit the dentist.
- Annual maximum
- The most your plan will pay in a benefit year. After that, you pay the full cost until the plan year resets. Most plans fall between $1,000 and $2,500.
- Deductible
- What you pay yourself before the plan starts paying for certain services, usually $50–$100 per person. Many plans waive it for cleanings and exams.
- Co-insurance
- How the cost is split. With 80/20 coverage, the plan pays 80% of the allowed fee and you pay 20%.
- 100/80/50
- A common coverage pattern: preventive care at 100%, basic care such as fillings at 80%, and major care such as crowns at 50%. Your plan may differ.
- In-network dentist
- A dentist who has agreed to your plan's discounted fees. Seeing an in-network dentist usually keeps your share lowest. We're in-network with more than 300 plans.
- Allowed fee (UCR)
- The fee your plan uses to figure its payment. In-network, the allowed fee is the full charge. Out-of-network, you may owe the difference between the dentist's fee and the allowed fee.
- Frequency limit
- How often a service is covered, for example two cleanings a year or certain x-rays every 12–36 months.
- Waiting period
- Time you must be enrolled before some services are covered, often 6–12 months for major work. Check with your employer or plan.
- Pre-treatment estimate
- A request to your plan, before treatment, for what it expects to pay. We recommend one for larger treatment, so you know your cost in advance.
Networks
In-network with more than 300 dental plans
Through direct contracts and partner networks, our dentists are in-network with these carriers and more:
- AetnaPPO plans
- Aflac
- Always Care / Unum
- Ameritas
- Connection Dental Network
- Blue Cross Blue Shield of IllinoisDental Network of America
- CignaDPPO
- Delta Dental Premier
- Dental Health Alliance (DHA)
- Delta Dental PPODr. Macias-Serna and Dr. Khan
- Envolve / Ambetter
- GEHA
- Guardian
- Humanasome plans
- Lincoln Financial Group
- MetLifePDP Plus and FEDVIP plans
- Mutual of Omaha
- Principal
- Sun Lifeformerly Assurant
- United ConcordiaElite network
- UnitedHealthcareincluding Medicare Advantage dental
Currently out of network: Anthem Blue Cross Blue Shield (Indiana); Tricare dental plans; Most Medicare Advantage dental plans (UnitedHealthcare is in-network, and Delta Dental for Dr. Macias-Serna and Dr. Khan). You're still welcome here; we'll explain your out-of-network benefits before treatment.
Plan networks change. Call or text (219) 836-2910 with your plan name and we'll confirm your coverage before your visit.
We check your coverage for you
Our front office verifies your benefits, estimates your share and explains what your plan covers before treatment begins. Call or text (219) 836-2910.
No insurance, or maxed out?
The Wadas Dental Membership Plan covers cleanings, exams, all x-rays, fluoride and an emergency visit, on a monthly or annual plan, with no deductibles and no waiting periods.
This guide is general information. Your plan's own documents decide what it covers.
Visit us
Evening hours, Monday to Thursday
9307 Calumet Avenue, 2nd Floor
Munster, IN 46321
(219) 836-2910
Call or text. New patients always welcome.
| Monday | 7:30 am – 6:10 pm |
|---|---|
| Tuesday | 7:30 am – 6:10 pm |
| Wednesday | 7:30 am – 6:10 pm |
| Thursday | 7:30 am – 6:10 pm |
| Friday | 8:00 am – 2:00 pm |
| Saturday | Closed |
| Sunday | Closed |