With most insurance policies renewing at the start of the year, Surf City Dental finds many of our patients exploring their coverage options in January. Whether you’re shopping around for a new policy or are simply trying to understand the one you have, there’s a lot to learn and consider. Below, we cover a few dental insurance basics that can help. Ready to drill in?

Terminology 101

There are several words and phrases you’ll find in just about every insurance policy, so first, let’s take a moment to cover their meanings.

Premium: The amount you pay monthly to be enrolled in an insurance plan.
Deductible: The dollar amount you must pay before your plan will begin covering costs.
Copay: The amount you pay every time you visit the dentist.
Coinsurance: The percent you’re required to pay after meeting your plan’s deductible.
Annual maximums: The highest amount your plan will pay for coverage each year.

Ask Yourself This…

In addition to understanding the terms above, consider a few questions before you begin wading through your insurance options. This will allow you to narrow down what’s truly important to you and your family and eliminate plans that don’t include what you need. For example:

  • Is your preferred dentist in-network or out-of-network?
  • What will the total estimated cost of the plan be? (premiums, copays, deductibles)
  • What is the annual out-of-pocket maximum?
  • Are there limits on pre-existing conditions?
  • Will it cover your anticipated needs? (routine care, major treatments)

P.S. – Talk about your expected needs with your Surf City Dental practitioner! Our team is always happy to help you plan out the best possible long-term care for your oral health.

What’s Covered?

Though every insurance policy is different, most dental plans follow a 100-80-50 schedule. This means they cover 100% of preventative care, 80% of basic care, and 50% of major procedures. Here’s a breakdown of what each area might include:

  • Preventative – cleanings, exams, x-rays
  • Basic – fillings, extractions, periodontal work
  • Major – crowns, dentures, implants, bridges, root canals


There are a variety of dental plans to choose from, each with their own pros and cons. Two of the most popular are Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO) policies. But, what’s the difference?

Preferred Provider Organization (PPO)
PPO plans provide enrollees benefits (often in the form of cost savings) for receiving care from an “in-network” or “preferred” provider. You can still visit an out-of-network provider, but your insurance will probably cover a smaller percentage of the cost. As a trade-off for the flexibility to visit any provider you choose, these plans often come with higher premiums.

Dental Health Maintenance Organization (DHMO)
DHMO plans are usually lower in cost than PPOs, but typically provide coverage benefits only when using an in-network provider. You’ll likely be required to pay out-of-pocket for visiting a dentist who is not in your network. Therefore, though HMOs generally cost less, they don’t provide the same flexibility as a PPO option.

No Insurance? No Problem!

Not at Surf City Dental, at least. Not only do we provide in-house financing options, but we also offer a Surf City Wellness Plan that can keep you and your family covered even if you don’t currently carry dental insurance.

Similar to most policies, our Wellness Plan provides each individual covered with two dental cleanings per year, dental exams, x-rays, and fluoride treatments. Get in touch to discover the full details!

Whether you have dental insurance or not, routine maintenance and preventative care are critical in sustaining a brilliant smile. Here at Surf City Dental, ensuring your smile stays bright is our #1 priority. In other words, we’ve got you covered! We look forward to assisting with your dental needs in the new year!