Visiting the dentist is not something you generally look forward to doing. However, it should be a vital part of your regular health routine. Making sure your teeth are clean and in good condition has a positive impact on your health. Regular visits to dental providers do not come cheap, but there are ways to reduce the amount you spend if you can snag the best dental insurance around.
The cost of dental care continues to increase, year after year, but it makes no sense to avoid having treatment simply because you can’t afford it. Choose the best dental insurance plan, and you’ll spread out the cost, protect against unexpected bills, and enjoy the affordable dental treatment.
Whether you’re an American who already has dental insurance or someone who needs to find coverage, this guide will answer most of your questions.
What is Dental Insurance?
Dental insurance is a type of health insurance, designed to pay a certain percentage of the costs involved in dental care. The care provided could be preventive, minor, or even major dental care.
A dental insurance plan works similarly to dental vision or a health insurance plan, with specific standard terms. For those of you who are new to this type of insurance, let’s first explain what they mean.
- Premium – the amount you pay to the dental insurance companies every month
- Deductible – the amount you must pay out-of-pocket before your insurance starts paying for your treatment
- Coinsurance – the percentage of covered expenses you are responsible for
- Copay – a fixed cost for dental x-rays and certain other services you may have
- In-Network – a list of dentists who have a contract with particular dental insurance companies
- Alternate Benefit Clause – an agreement which allows insurance companies to only pay for cheaper alternative procedures
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Different Types of Dental Insurance
There are several different types of excellent dental insurance plans. Now that you’re acquainted with some of the basic jargon, we can take a closer look at what they are.
DHMO (Dental Health Maintenance Organization) Insurance Plan
This is the most affordable type of dental insurance. However, this means they have their limitations. To take advantage of HMO plans, you choose one particular dentist that is responsible for your care. This one preferred dentist is also the one that refers you to any specialist work needed. Additionally, any dental care required has to be done by a dental practice within your chosen network.
The upside of this plan is that there is no upper spending limit and no long wait for treatment. There may, however, be some limitations regarding the frequency of your visits.
This type of plan is perfect for those on a limited budget and people who don’t want to wait months for their dental care.
DPPO (Dental Participating Provider Network) Insurance Plan
These are also known as PPO plans. They offer better flexibility, as they’re widely accepted nationwide. You’ll choose a preferred dental network, which saves a ton when used. However, there’s also the option of choosing to have dental work done outside your selected network.
Referrals aren’t required if you need to see a specialist. However, for anything other than basic work, you might have to wait several months, sometimes even a year.
With this plan, there is a $1,000 to $1,500 spending limit.
If you’re looking for a plan that allows you to choose your low-cost dental care provider, this one is for you. It’s also going to be a better option if your oral health is generally good, and you usually only require preventive care.
Dental Indemnity Insurance Plan
Also known as a ‘Traditional’ plan, this is the most expensive type of dental insurance. In today’s dental insurance market, it’s a plan that doesn’t get offered very often.
In many ways, it’s much the same as the previous type of plan, although the maximum is generally between $2,500 and $3,500.
If you sign up for this type of insurance, you’ll need to be able to pay for your dental care bill at the time of treatment. Afterward, you can apply for a reimbursement check from your insurance provider.
Another downside is that you may have to wait a certain length of time if you need restorative care. This makes it not such an attractive insurance for a discount option.
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Can you have more than one dental insurance policy?
Well, there’s the million-dollar question. With some dental procedures costing thousands of dollars, you can quickly reach the maximum limit of your policy. Having more than one plan seems like the solution, but it’s not as simple as that.
It is possible to have two different dental plans, and it’s known as dual coverage. You might have the best dental insurance coverage through two providers, or be covered by your employer’s dental benefit as well as having insurance of your own. If you want to, you can even combine them to minimize your out-of-pocket expenses.
Before agreeing to expensive dental treatment, make sure you understand your full coverage under both policies. Never automatically assume both providers are going to pay. The policy details will let you know which services are covered by each policy. It also shows whether there are any waiting periods and how they coordinate benefits.
Coordination of Benefits
It’s not automatic that both insurance plans will cover the cost of your dental care. One program will payout first, and the secondary plan will kick in after the primary claim paid. This prevents overpayments and avoids delays in the processing of claims.
Plans generally have a coordination of benefits clause, which means there are special rules which determine the order. The details of these rules are in your insurance plan contract. If your plan has no such clause, it automatically becomes the primary plan.
Dental plans often coordinate benefits so that all eligible claims can cover 100% of the cost for proper treatment. An application made under the primary plan pays, with the secondary plan paying whatever is left. Coverage limits, of course, have to be taken into account. You also need to look carefully for clauses such as maintenance-of-benefits, non-duplication-of-benefits, and carve-out provisions. These can reduce what is paid out and leave you to cover some of the costs.
Why You Need Dental Insurance
As if going to the dentist wasn’t enough, there’s also the matter of the hefty bill. Dental work can be costly. Your employer may cover some of the cost, but you might also have to pay for yourself.
If you want to take care of your overall health, dental care has to play a part. You can do your part with regular brushing and flossing, but only a dentist or dental hygienist can keep your teeth completely clean. Visiting your dentist helps to reduce the risk of decay and cavities, as well as to catch any problems with your teeth early.
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Dental insurance is also important because:
- It covers preventive care – because you’re able to visit the dentist more regularly, your dentist can find any issues before they become a problem.
- Treatment will cost less – treatment that is covered under your dental insurance costs less.
- It saves time – if your dental health is improved because you can visit the dentist more often, you’ll be saving on hours of lost work and school time.
- It can lead to health improvements – Research has shown that there are links between dental and overall health. Many medical conditions can be detected by examining the mouth, neck, and throat. Poor dental hygiene and the resulting infections can make certain illnesses or conditions worse. Regular check-ups at the dentist, therefore, help to keep you healthy.
What types of treatments are covered by dental insurance?
The treatments covered under individual dental insurance policies are going to differ. It is possible, however, to give you a general idea of what you can expect.
The best dental insurance plan for you can cover some of the cost of preventive care. Preventive care includes:
- Routine oral examinations
- Dental X-rays
- Fluoride treatments
These are considered to be preventive because they help to identify and prevent new dental issues. Brushing and flossing are also considered to be preventive care, but this is up to you.
The best dental insurance plans also cover a percentage of the cost of fillings, root canals, crowns, and oral surgery, such as an extraction.
You can even find plans that cover orthodontic and periodontic care. These cover most structures that support and surround teeth, such as braces. Dentures and bridges (prosthodontics) might also be included.
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Dental Services Classes
Dental services are usually broken down into several classes.
- Class I – preventive and diagnostic care, for example, cleaning, examinations, and X-rays
- Class II – necessary procedures and care, for example, root canals and fillings
- Class III – major procedures and care, for example, bridges, dentures, and crowns
- Class IV – orthodontics and periodontics such as braces
When you’re deciding which insurance coverage to pay for, these are the insurance dental classes to keep an eye on. Most dental insurance providers include Class I and II care. For the other classes, however, you might have to pay higher premiums.
Be sure to consider how many preventive visits you’re allowed? In most cases, you’re only provided two per year. The timing of your visits is therefore essential, as some policies only pay for one preventive visit every six months. Check the wording on your system very carefully, and discuss anything you’re not sure about with the insurance provider. Some of the other services that are covered may also have a time limit.
If you have any dental conditions which existed before you started your insurance coverage, they probably won’t be covered. Any ongoing treatment usually has to be paid for out of your own pocket.
Is there a dental insurance plan that covers everything you need?
Once upon a time, not so very long ago, it was possible for any dentist or dental care professional to accept your dental care insurance. You would pay for whatever you needed doing, and then your insurance provider would reimburse a large percentage of the cost. If you needed significant dental work done, your dentist could even work with you to negotiate a billing plan, saving you from paying it all at once.
This type of insurance, indemnity insurance, is still available, but it’s not a standard option. It is, however, as close as you can get to comprehensive dental care cover.
Another benefit of this type of insurance is that the maximum amount covered is generally much higher than other types of insurance.
Like the sound of this type of insurance? Be aware that it does come at a high price. Monthly premiums can range from $65 to $780, while a preferred provider or in-network dental insurance costs as little as $350 for the whole year.
How Dental Insurance Works
Dental insurance works similarly to medical health insurance. After you choose your insurance plan and pay your monthly premiums, certain costs are covered depending on the benefits attached to your plan.
Class I work is often covered 100%, while other dental care classes will be subject to copay and deductibles. Once the deductibles have been met, you’re responsible for either copayment or coinsurance. This is the percentage of the cost that you have to pay. Every dental insurance plan is different, which is why it’s essential to check out the details before you sign up for any plan. Understanding your coverage is vital.
You may find that some of the plans you look at impose a waiting period, typically seen for Class III procedures and above. You’ll have to wait until your plan has been in force for a given time before being eligible for these procedures. This might seem a little unfair, but it protects insurance companies. Specifically, it prevents people from signing up for insurance right before major dental surgery and canceling without continuing their premiums.
Factors to Consider When Choosing Dental Insurance
Choosing the best dental insurance plan can be a minefield for the uninitiated. There are so many different plans to choose from you might not know where to start. You want a plan to cover as much of the dental care you and your loved ones need. Not just immediately, but into the future as well. Here are some of the most important factors to keep in mind when buying a dental insurance plan.
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1. Start Looking Today
Don’t be tempted to wait until you need some dental care to start looking for the best dental insurance. Sort out some cover as soon as possible, and you’ll be in a better position should you need to visit the dentist.
Certain types of dental work may not be eligible during the first few months of your coverage. Finding you need root canal work or a crown and then have a waiting period to contend with is not a great place to find yourself.
2. Cheapest is Not Necessarily the Best
Dental plans with the lowest premiums might seem very attractive, but does it suit your needs? There’s no one size fits all dental insurance plan because everyone’s needs are different. You want a plan that suits your budget but also meets your needs. It’s even better if the policy covers as much of your dental care costs as possible.
Dental plans vary considerably, so be sure to spend some time evaluating your options. Look at annual maximums, procedures included, as well as those that aren’t, waiting periods, in-network provider list, and whether the plan covers treatment at a dentist from outside the network.
3. Copays and Deductibles
Copays and deductibles are in almost every kind of dental insurance plan. There are very few plans that cover 100% of the cost of your dental care. When you visit the dentist, for whatever reason, you’ll likely have to pay a portion of the bill.
The copays and deductibles are going to be different for every policy, so check the small print and choose a plan that best suits your budget.
4. What the Plan Covers and What It Doesn’t
It’s essential that you fully understand everything included in your plan. Equally important is an understanding of what’s not. The majority of dental plans cover primary care, such as preventive examinations, cleaning, and x-rays.
Cosmetic work, on the other hand, is rarely included. You’ll need to read the fine print of your insurance plan proposal. If there’s anything, you’re not sure about always be sure you ask.
5. Choice of Dentist
If you’ve already been going to the dentist for several years, you’ve probably got one you know and trust. If you’re considering dental insurance, make sure your dentist accepts the company and policy you choose. The plans you’re looking at will have a list of acceptable providers, and with any luck, your dentist is on that list.
However, if you don’t yet have a preferred dentist, check which dentists are “in-network.” These are dentists who have entered into a contract with the insurance company and agreed to offer reduced fee procedures or set fees. If you need to go to a dentist that’s out of the network, your insurance company may not pay quite as much.
6. Waiting Periods
You might be disappointed if you enroll in a dental insurance plan and are expecting to see a dentist straight away. Most policies have a waiting period for treatment other than examinations and cleaning. Even if you need root canal work or a crown and it’s causing you pain, you may have to wait six months, possibly even one year. Check the waiting period in the insurance details or make sure you ask about them before signing on the dotted line.
7. The “Maximum Allowable”
Another factor that’s common amongst most types of dental insurance plans is a maximum allowable clause. That is the total amount, in dollars, that your insurance company will pay out in one year. Generally, it’s somewhere around $1,500, but it could be more or less depending on the individual company and insurance plan.
8. Price Versus Benefits
Dental insurance can be costly, and prices vary considerably. When it comes to deciding which one is right for you, spend some time carefully weighing the cost compared to the benefits. A cheaper plan might suit your budget better, but it’s also likely to come with far fewer benefits. That means you’ll face more out-of-pocket expenses in the long run.
There are other types of dental cost cover you can choose, and we’ll look at those a little later.
9. Eligibility for Group Coverage
Group coverage programs include AARP, Medicaid, Children’s Health Insurance Program, the Affordable Care Act marketplace health insurance policies, or TriCare for the military. They tend to be a little more affordable than buying an individual insurance plan. Some of them also have better benefits, as well. You might also be able to get coverage through your employer. If there’s not a program in place, you could talk to your boss about getting one.
Choosing the right dental plan isn’t easy. However, you now have a basic understanding of what a dental plan is. You also know what to look for and how these plans work. There are hundreds of different plans to choose from, but to make things a little easier, here’s a list of some companies you should approach for more details.
Top 5 Dental Insurance Companies to Consider
Dental insurance varies considerably from company to company. The cover might include just preventative care or more catered for dental procedures. Here are the top 5 dental insurance companies and what they have to offer.
The most successful of AETNA’s plans is its group dental insurance offered through employers. If you live in certain states, for example, Alaska, Arizona, Delaware, Illinois, and Pennsylvania, purchasing dental insurance direct from the company is also an option. The plans offered are PPO insurance plans, the details of which vary according to where you live. The network only plans are also available, together with a dental indemnity plan.
One other option for you to consider is a dental savings plan. It’s a discount dental plan with no annual limit and no waiting time. Participate in this type of policy, and you can save as much as 50% on most dental procedures, including implants and braces. More than 160,000 dentists participate in the scheme, with savings on hearing, vision, and prescription medications also offered.
Guardian offers family and individual dental insurance plans. Coverage includes regular examinations, cleaning, as well as bitewing x-rays and other types of x-ray. A range of policies are available, but the benefits vary from state to state. For customers’ convenience, the company provides an online tool that can be used to find Guardian network dentists in their local area.
Overall, Guardian Dental provides good coverage options and prices that suit most budgets. To know more, visit the Guardian Direct website.
Humana can offer you a wide selection of dental plans, depending on your needs. It is the 3rd largest health insurance provider in the US, with more than 13 million customers.
You can choose between four dental insurance plans and one dental savings plan. Let’s look at one of the plans in a little more detail.
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Humana Complete Dental
Humana Complete Dental is a PPO plan is designed for people who have already had dental insurance previously. It includes 100% coverage for diagnostic and preventive services and no waiting fee. The annual deductible is $50 for an individual or $150 for a family. For the first year, the annual spending limit is $1,250, but this increases to $1,500 in the following years.
AARP DENTAL INSURANCE
AARP stands for The American Association of Retired Persons, and it offers dental plans administered by Delta Dental. Two dental insurance plans are available, and as you might expect, they are designed as dental insurance for seniors. Comprehensive coverage is one feature along with three cleanings per year, rather than the usual two. There is also good coverage for dental implants, denture needs, bridges, and crowns.
One downside of the plans is the twelve-month waiting period before your treatment is covered. However, there is a long list of network dentists you can go to, and out-of-network dentists are allowed.
As you might expect, because of the high level of coverage, premiums are a little higher than average. You also need to be an AARP member.
Metlife is another insurance provider that focuses on providing dental insurance for businesses. There are presently more than 20 million people who benefit from one of their plans.
There is also an individual dental insurance plan called TakeAlong Dental. Benefits include:
- In-network dental care with fees that are on average 36% lower than dental care in the area.
- Hundreds of services and procedures covered, for example, cleaning, x-rays, fillings, crowns, root canals, sealants, and orthodontics.
- Waiting periods, for anything other than preventive care, is ranging between 6 months and one year.
- You may be eligible to have the waiting period waived if you’ve had comparable dental cover in the previous 12 months.
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What to do Before You Visit the Dentist
Before you make an appointment for any dental procedure, sit down, and check your policy. If you have any questions or concerns, speak with your insurance provider’s representative. You should also talk to your dentist and make sure they recognize your insurance coverage and can help when it comes to reimbursement.
If significant work is needed, it’s possible to ask your dentist for a pre-treatment estimate. Knowing the cost allows you to work out how much you’ll have to pay after the copay and deductible are taken out. You’ll also see whether it’s within the policy limitations.
Making a Dental Insurance Claim
If you’ve already got insurance and are wondering what happens if you need to make a claim here’s a quick explanation. There are usually two options: either the dentist can claim on your behalf, or you can submit the request yourself.
When Your Dentist Claims on Your Behalf
Your dentist will first ask for details of your insurance. The claim can be sent through the mail or filed electronically. Many dentists prefer the latter option because it’s much more comfortable and far more efficient. The dentist may also have to send copies of any x-rays and other documentation relevant to your treatment. You may need to pay a certain percentage of the cost upfront with your insurance covering the rest. If you overpay, your dentist will reimburse you. Alternatively, they could also come back to you and ask for further payment.
With the claim submitted, you need to wait while your insurance provider checks all the information. They need to check whether your plan covered the treatment, for example. Once everything is in order, your dentist receives the payments. If you paid the full cost of the treatment upfront, the insurance providers reimburse you directly.
If You Need to Submit a Claim Yourself
Some insurance companies prefer the policyholder to submit the claim themselves. In this case, you’ll have to pay your dentist for the treatment and file a claim for reimbursement. You’ll need to provide details of the treatment you received along with receipts, x-rays, and other relevant documentation.
You can submit your claim electronically or by mail. The request is then reviewed and hopefully approved. If any information is missing, however, they’ll be sure to notify you. You’ll then receive payment from your insurance provider that covers all, or part of the cost. The complete process shouldn’t take much longer than a few days.
Other Types of Dental Cost Coverage
You’ve already had an introduction to dental insurance plans. However, there are also several other options if you want to reduce the cost of any dental treatment you receive.
This type of cover focuses on how much you spend, rather than the kind of treatment you receive. The plan is self-funded, and you’re allowed to visit a dentist of your choosing. You either pay the dentist directly or have the benefit sent to the dentist. Payment happens after the submission of a paid receipt or proof of treatment.
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Point of Service Plans
If you already have a managed care plan, a point of service plan allows you to look for treatment outside of your network. Reimbursement is given based on a table of allowances. As such, the benefits are much lower than if you’d received treatment from a dentist within the system.
Discount or Savings Plan
Dental discount plans are not insurance plans. The company that offers this sort of program will have entered into a contract with a network of dentists. Dentists within that network provide discounts on their dental fees. You are responsible for paying all the treatment costs, but they are at a discounted rate. This type of plan is becoming very popular with employers.
The benefits of this type of plan are:
- No waiting periods
- No copays
- No paperwork – you show your membership card when visiting a participating dentist
- No restriction on immediate treatment for expensive treatment or pre-existing conditions
- No annual limits
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Exclusive Provider Organizations
Subscribe to this type of plan, and you’re only able to receive treatment from a participating dentist if you want the cost reimbursed. There is often a limited choice of dentists, which can severely limit access to care.
Table of Schedule of Allowances Plans
With this type of plan, you receive a set amount for every procedure. How much you pay for your treatment makes no difference.
Supplemental Dental Insurance
Your dental care needs could exceed your dental insurance plan, so it is possible to have a supplemental insurance plan. It can be for just one year or two, if, for example, you need to pay for braces or dental implants. Additional dental insurance is a popular option for people who are on Medicare.
Let’s review. If you want to take care of your own or your family’s dental needs, it makes sense to pay for dental insurance as soon as possible. You’ve now got all the relevant information to help you make an informed decision and find the right plan for your needs. There are hundreds of different dental insurance plans to choose from, but if you do your research, you’ll be sure to find the right coverage.
Don’t put off going to the dentist because you’re worried about the cost. Good dental hygiene plays an essential part in your health and wellbeing. Remember: you’re not alone in worrying about visiting the dentist. However, with the right insurance coverage, you don’t have to worry as much about the costs.
We’d love to hear about your experiences, and there are plenty of others just like you who would value any advice you’ve got to share.