EMI Choice Senior Advantage Copay Dental Plan
EMI Health's Senior Advantage Copay Plan is a rich dental benefit plan. This plan is a copay plan, which means you pay a fixed copay for covered dental services and procedures. Once you've met your deductible, you just pay the copay and they will pay the balance of your in network bill.
Carrier
EMI
Plan Year
2025
Individual and Family Deductible
Dental insurance deductibles work similarly to health insurance deductibles, but they apply specifically to dental care. Individual deductibles are the amount a person must pay out-of-pocket for covered dental services before the insurance starts covering a portion of the costs. In a family plan, each family member has their own individual deductible, but many plans also have a family deductible cap, meaning once the family’s combined spending reaches a certain limit, the insurance will kick in for all members. These deductibles generally apply to services like fillings, crowns, and other restorative treatments, but routine care such as cleanings and exams may be covered without needing to meet the deductible. Understanding how these work ensures you're prepared for any out-of-pocket costs when seeking dental care.
Individual Deductible
$25
Family Deductible
$75
Preventative Care
The EMI Senior Advantage Copay Dental Plan prioritizes preventive care by covering it at an exceptional 100% when members choose to receive care from in-network dentists. This robust benefit ensures that crucial preventive services such as regular check-ups, cleanings, and X-rays come at no additional cost to the members, making it convenient and budget-friendly to maintain optimal oral health. By covering preventive care at 100%, the plan encourages individuals to schedule routine appointments, catch dental issues early, and prevent more extensive and costly treatments down the line. This emphasis on preventive care not only promotes healthier smiles but also underscores the plan's commitment to supporting overall well-being through accessible and comprehensive dental coverage.
Minor Dental Services
The EMI Advantage Copay Dental Plan includes coverage for minor dental work, but it comes with a 6-month waiting period. This means that for the first six months of enrollment, members may not be eligible for coverage on minor procedures such as fillings and other basic treatments. While the waiting period may require some patience, it's important to note that this feature is designed to ensure the plan remains cost-effective and sustainable over time. Once the waiting period has elapsed, members can access coverage for minor dental work, making it easier to address common dental issues while enjoying the cost-saving benefits of the plan's fixed copay system for such services. This approach balances affordability with comprehensive coverage, ultimately promoting long-term oral health and financial well-being.
Major Dental Services
The EMI Advantage Copay Dental Plan extends coverage for major dental work, but it involves a 12-month waiting period. During the first year of enrollment, members may not have coverage for major procedures such as crowns or other extensive treatments. While this waiting period requires a degree of patience, it's implemented to ensure the plan's sustainability and affordability. After the 12-month waiting period, members can access coverage for major dental work, allowing them to address more significant dental issues while benefiting from the fixed copay system, which translates into substantial discounts ranging from 25% to 80%. This approach strikes a balance between accessibility and cost-effectiveness, encouraging members to prioritize their long-term oral health and financial well-being while considering the waiting period as part of their dental care planning.
Orthodontia for Children
It's important to note that the EMI Advantage Copay Dental Plan does not include coverage for orthodontic treatments. Orthodontics, such as braces or aligners, are specialized dental procedures with their own unique considerations and costs. By excluding orthodontic coverage, this plan can maintain its focus on preventive, basic, and major dental services, keeping it straightforward and cost-effective. Individuals seeking orthodontic treatment may need to explore alternative financing options or consider supplemental insurance plans specifically designed to cover orthodontic expenses, while still benefiting from the comprehensive dental coverage provided by the EMI Advantage Copay Dental Plan for other dental needs.
Implant Coverage
The EMI Advantage Copay Dental Plan also does not cover dental implants. Dental implants are specialized and often expensive procedures aimed at replacing missing teeth with artificial roots and crowns. This plan focuses on preventive, basic, and major dental services while omitting coverage for dental implants to maintain its affordability and simplicity. Individuals considering dental implant procedures should be aware that they may need to explore alternative financing options or consider supplemental dental insurance plans tailored to cover implant-related expenses. Despite not covering implants, this plan remains a valuable choice for comprehensive dental coverage in other areas, ensuring essential dental care is accessible and budget-friendly.
Maximum Yearly Dental Benefit
One of the outstanding features of the EMI Advantage Copay Dental Plan is its unlimited maximum benefit, which sets it apart from many traditional dental insurance plans. With no maximum benefit limit, members have the freedom and flexibility to use the plan as much as they need without worrying about exhausting their coverage. This means that whether it's for preventive care, basic treatments, or major procedures, the plan provides continuous financial support, ensuring that members can access the dental care they require, even if they have ongoing or recurring dental needs. The unlimited maximum benefit offers peace of mind, making the EMI Advantage Copay Dental Plan a reliable and comprehensive choice for those seeking long-term dental coverage that adapts to their changing needs over time.
Full Summary of Benefits and Helpful Links
Official documents, such as your insurance policy or Summary of Benefits and Coverage (SBC), outline the details of your coverage, including deductibles, copayments, and covered services. Provider links, often available through your insurance company's website, offer directories of in-network healthcare professionals and facilities, helping you find the right dentists that are covered by your plan. Utilizing these resources can empower you to make informed healthcare decisions and effectively navigate your insurance coverage.
Helpful Links
Schedule a consultation with a local health insurance agent
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This is a quick snapshot of the most popular copays, deductibles, and coinsurance that you would be responsible for on this dental plan. Preventative services include dental cleanings, exams and x-rays. Most plans cover your preventative care every 6 months with no waiting period. Basic dental work includes minor services like filling a cavity and may have a waiting period before these services will be covered on your plan. Major work includes services like crowns and root canals and may have a waiting period before these services are covered. Dentures and implants are normally NOT included in dental insurance. If you need coverage for these services, please let your local agent know so that you have a plan that includes those services.
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To learn what each of the terms mean, please visit our terms and definitions page. Copays and coinsurance listed are amounts that you would pay after deductible unless specified otherwise. This is not a full list of services included on the plan. This snapshot is not guaranteed to be accurate. To verify plan benefits or for full details please see the full summary of benefits or or get a complete terms of coverage on the health plan carrier's website.
PPO Plans and Out of Network Limitations and Balance Billing
Some dental plans offer out of network coverage. This is a great benefit because you can visit any dentist in the nation. Which means that if you are traveling, or have a dental emergency, you can visit a dentist for the service you need right away and have a portion of your bill covered by your dental insurance. Please note that if you see an out of network provider, that dentist is allowed to "balance bill" you. This means that your dental insurance company pays your dentist what is reasonable and customary for the services you received. In most situations that dentist accepts that payment and you are only responsible for your portion of the bill. Occasionally, that dentist will decide that the reasonable and customary amount they received from the dental insurance is not enough. That dentist will bill you for the additional charge or 'balance bill' you. You are responsible to pay this amount and contact the dentist to work out a payment plan.
