Dental insurance may mean the difference between staying healthy or putting off important oral healthcare. Choosing a plan can help you keep your smile a little longer. But some people put off care because their insurance doesn’t cover the treatment at all, while others do so because they’ve used their maximum coverage for the year. To avoid this, consider four key factors when buying dental insurance: availability of group coverage, cost of individual plans, in-network providers, and policy coverage.
Key Takeaways
- The best dental insuranceprovides coverage to help pay for expensive dental work.
- PPOs and HMOs plans may require you to stay in-network.
- Compare group and individual policies and find out which providers are in-network.
- Be sure you’re aware of which costs the policy covers and how much you’ll have to pay out of pocket.
The Basics of Dental Insurance
Dental insurance gives you coverage to help pay for dental work. These policies can help you pay for all or part of the work dentists perform, from routine cleanings and X-rays to more complicated ones such as implants.
Although dental insurance works a little like health insurance, the premiums are typically much lower—but, of course, there’s a catch. Most health insurance policies cover a hefty percentage of even large expenses once you’ve paid your deductible. This is not the case with dental insurance, which usually follows a 100-80-50 coverage structure for in-network dentists.
If you are using in-network dentists, dental plans generally pay:
- 100% of preventive care, such as exams, X-rays, and cleanings
- 80% of basic procedures, such as fillings, root canals, and extractions
- 50% of major procedures such as crowns, bridges, implants, and gum-disease treatment
Many dental insurance plans also have an annual out-of-pocket maximum, along with the deductible. This is the maximum amount that you will have to pay during a year you have coverage.
Orthodontia or braces may not be covered at all, but they are covered by some plans.This means you may still have to pay a hefty price for some types of dental work.
Types of Dental Plans for Sale
Dental policies range from group insurance to individual and family plans, and they come in two main categories.
Preferred Provider Organization (PPO)
A preferred provider organization (PPO) is one of the most common types of plans available. Dentists join a PPO network and negotiate their fee structure with insurers. If you decide to use an out-of-network provider, you’ll have to pay more out of pocket.
These plans can be more expensive because of the associated administrative costs. They also provide more flexibility than other plans because they often come with a wider network.
Health Maintenance Organization (HMO)
With a health maintenance organization (HMO), you’ll pay monthly or annual premiums but are restricted to the network, and you may have to live within the area where the HMO is offered. It's generally the cheaper than a PPO, with dentists agreeing to charge fees for specific services.
One more plan type, indemnity plans, aren’t common. Most insurance companies that offer indemnity plans require you to pay for the entire cost and file a claim. Once the claim is approved, the insurance company reimburses you for its portion.
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1. Find Out if You Can Get Group Dental Coverage
You may have dental insurance benefits available through your employer or other group coverage programs such as AARP, Affordable Care Act marketplace health insurance policies, or public programs such as Medicaid, Children’s Health Insurance Program (CHIP), and TriCare for the military.
These plans are generally less expensive than purchasing individual insurance and may also have better benefits. However, you should take a good hard look at the details of even an employer-sponsored plan to decide whether the premiums are worth the money for someone in your situation.
Though group coverage through an employer-sponsored plan is often the best way to get dental insurance, that still doesn’t mean that the plan will be right for you. Always check out the specifics of coverage and network before joining one.
2. Look Into an Individual Dental Insurance Policy
Individual policies are more expensive than group policies, whether you’re buying a single policy or one for your entire family, and there are drawbacks with this coverage. Insured parties often have to wait before major procedures are approved.
If you plan on signing up for a plan just in time because you need implants or a new set of dentures, your procedure may not be covered. Insurers usually institute a waiting period before you can start using certain benefits, lasting for anywhere between a few months to a year or more, depending on the procedure. There are some plans without waiting periods, but they typically feature very low coverage limits in the first year.
Before you make a decision, it’s best to comparison shop. Get price quotes and policy details from insurance company websites or talk to a knowledgeable insurance agent.
3. Find Out Which Dentists Are in Your Network
If you have a dentist you like, ask which insurance plans they accept. As mentioned above, indemnity insurance plans allow you to use the dentist of your choice, but PPO and HMO plans limit you to dentists in their networks. Your dentist may or may not be in the network, but if you don’t mind using a new dentist, a PPO or HMO might fit your needs.
Still, it’s wise to be wary. It’s possible that a new dentist you visit will say that you need a great deal of unexpected and potentially unnecessary work. Ask health professionals, neighbors, and friends if they can recommend a local dentist they trust. Then check what insurance and discount plans those practitioners accept.
4. Know What the Dental Policy Covers
Carefully review the policies you’re considering in order to budget for your dental expenses—both expected and possible emergency costs. For example, a plan may cover exams, cleanings, X-rays, fillings, tooth removals, root canals, gum cleanings, and denture repairs from when the policybegins.
However, you might need to wait until your second year to get benefits for dental implants, crowns, gum disease treatment, complete dentures, and TMJ treatment (which involves problems with the temporomandibular joint, which connects the jaw to the skull). Even then, the benefit is limited to 50% of costs.
With both group and individual policies, remember that benefits are limited and can vary significantly. Group plans may also have waiting periods, and almost all plans pay only a fraction of the costs for major work, so check the details. Your coworkers or friends may be insured by the same company but have a different benefit package than the one you're offered.
What is Most Important in Choosing Dental Insurance?
According to a 2023 survey conducted by Global Strategy Group (GSG), people satisfied with their dental plans appreciated easy access to local, in-network providers and specialists, feeling like good value is provided, and preventive care coverage, along with overall affordability.
What Is the Difference Between a Premium and a Deductible?
A premium is the monthly payment you make to keep your insurance policy active. A deductible is the amount that you are responsible for paying for a covered service before your insurance coverage kicks in. For example, if you have a $500 deductible and you need to have several cavities filled at a total cost of $1,000, you will pay the first $500 (the deductible) completely by yourself. The remaining $500 will be covered at your plan's coverage percentage for fillings, usually 80%. This means the insurance company will pay $400 and you'll pay $100. In total you pay $600 and the insurance company would pay $400. The deductible is only paid once a year, so for the rest of the year the entire cost of all remaining dental services will be covered at their specified percentage.
Is It Better to Have a High Premium or a High Deductible?
If you have few pre-existing conditions or problems, and your dental health is generally good, you may not need much more than preventative care. In this case, it would be better to have a higher deductible and a lower monthly premium. However, if you anticipate needing more dental services, a higher premium and lower deductible would likely save you money over time.
The Bottom Line
The bright spot of dental insurance is that coverage is good for preventive care, such as checkups, cleanings, and dental X-rays. Adults and children with dental benefits are likelier to go to the dentist, receive restorative care, and experience greater overall health. Purchasing insurance may motivate you to get preventive care and avoid more expensive and uncomfortable procedures. When purchasing individual dental insurance, be aware that major procedures may not be covered in the first year, and even then, the benefit is likely to be only half of what the dentist charges. You’ll need to set aside money in a health savings account (HSA) or personal fund so you’re not caught short if you need major work.
