Not so many Americans are aware of dental insurance plans and their benefits. According to data, 79% of Americans only know of dental benefits, a less thorough coverage for dental needs.
Dental insurance plans are crucial to affordable dental care at approved facilities nationwide. Medicare typically doesn't come bundled with dental insurance, meaning you must get this coverage separately.
However, affordable dental insurance plans are available within your state's public health insurance exchange or marketplace. To get the most affordable plan, you need to pay attention to the network, copays, deductibles, and annual maximums.
Here's what you need to know about dental insurance plans and how to find one that suits your needs.
What is Dental Insurance?
Dental insurance is insurance coverage that covers your dental care and health. Dental insurance ensures that you're always on top of your oral health by helping you pay for dental care costs.
Dental insurance covers are usually provided as standalone by most insurers. Therefore, you have to bundle it with your medical insurance coverage or buy it as standalone coverage through a dental insurer, a private insurance broker, or the health insurance marketplace.
The Different Types of Dental Insurance Plans
There are various types of dental insurance plans based primarily on the dentists you can visit and out-of-pocket costs. The most common ones include the following:
Dental Health Maintenance Organization (DHMO)
A DHMO plan requires that you only visit in-network dentists. This plan provides no maximum coverage limit or deductibles. You may also not need a copay for certain procedures.
Dental Preferred Provider Organization (DPPO)
This dental insurance plan allows you to visit any provider. However, in-network dentists will have lower out-of-pocket costs. DPPO plans include copays, annual coverage limits, and deductibles for the procedures.
Discount Plan
Discount plans are typically annual membership plans that give you discounts on dental services. With this plan, you'll foot all costs out-of-pocket, albeit you'll be offered a discount on your bill.
Discount plans have no network limitations. However, the out-of-pocket costs are higher.
Fee-for-Service
A fee-for-service plan allows you to pay the copay and fee for a dental visit and later get reimbursed partially or fully by the insurer. This plan also has fewer network limitations.
How Dental Insurance Works
Like typical medical coverage, dental insurance coverage requires selecting a coverage plan based on approved dentists or providers and your budget. Therefore, if you already have a dentist who's within the insurer's network, you can select a plan that's affordable and within your budget for that provider.
However, if you don't have a preferred dentist, you can select any from the insurer's network and choose the more affordable option for that provider.
In cases where your preferred dentist is not part of the insurer's network, you'll have to pay significantly higher premiums to get coverage. Sometimes, the premiums may be too expensive, making dental insurance a less logical option.
Therefore, your dental insurance premiums depend largely on location, company, and the plan. In most instances, people pay around $50 monthly premiums, translating to $600 annual dental insurance costs. This cost is spent regardless of whether you got an actual procedure done.
You can explore more affordable dental insurance plans by looking at a Medicare Advantage plan, group plan, or other means offered by your insurer.
The Difference Between Dental Benefits and Dental Insurance
In most organizations, employees are offered dental benefits instead of dental insurance. While dental insurance will have some benefits, dental benefits and dental insurance are not the same thing.
A dental insurance plan absorbs the risk and costs of a dental procedure, allowing you to get affordable dental health services. Therefore, if you have to get a tooth pulled or a root canal, you'll not foot all the costs out of pocket, depending on your policy.
On the other hand, a dental benefits plan covers certain things in full, some partially, and leaves other procedures or costs fully uncovered. Therefore, a dental benefits plan is only designed to help cover some of your dental health needs but does not catch all scenarios and provide more comprehensive coverage.
What is Covered by Dental Insurance?
The total coverage and benefits of your dental insurance will depend on the plan and the provider. For instance, dental insurance provided by an employer, a state's Medicaid program, a public health insurance marketplace, a private insurance company, or a Medicare Advantage plan will all have different coverages.
Depending on your policy, you may get full coverage for routine exams and cleaning and significant coverage for extractions and fillings as long as your deductibles have been met.
With some plans, you also get coverage for cosmetic orthodontia procedures. This procedure is often covered under pediatric dental coverage, typically acquired through the health insurance marketplace. However, most insurers will only approve the cover if deemed medically necessary.
Given the significant variance in coverage for most dental insurance plans, it's crucial that you carefully review each plan to know the exact coverage and make an informed purchasing decision.
How Much Does Dental Insurance Cost?
Just like coverages vary significantly for dental insurance plans, premiums also have a huge variance. Adult dental coverage plans come in various forms, with the premiums varying based on the coverage, deductibles, and other factors.
However, in most cases, higher premiums for a cover translate to lower out-of-pocket costs, higher benefits caps, and shorter waiting periods. Therefore, more expensive dental insurance plans will cover the full cost of cleaning, preventive care, routine exams, sealants, and X-rays as long as in-network providers provide them.
Plans with lower premiums will cover a small portion of these costs, leading to higher out-of-pocket costs.
Therefore, you must carefully assess the details of each plan and understand the coverage plus the out-of-pocket costs you'll have to pay for the dental services you will need.
Depending on your needs, you may discover that smaller plans with preventive care benefits are more affordable since you don't anticipate any major dental health concerns in the future.
Depending on your location, the cost of routine dental services, such as x-rays, checkups, and cleaning, will help determine the reasonable amount you should be paying for dental insurance coverage.
Get Expert Guidance
Getting dental insurance at the right time for the right costs can help offset significant bills from dental services. Talk to an expert and learn which options suit your needs best.