Oral health is an essential aspect of overall health, but choosing a dental insurance plan can be time-consuming. Each plan presents itself as the best; however, we then spend hours cutting through the jargon to find whether or not the inclusions are worth the monthly dental insurance cost. Let’s take a look at what each type of dental insurance is, what their inclusions are, and how to determine if the fees give you the best value for money.
Like medical insurance, dental insurance can help you or your entire family save on dental care.
Dental insurance costs are based on the services your plan covers, and the set coverage limit (if applicable).
Your insurance company will likely provide several dental plans that focus on the basics and preventative care, or extend to major procedures.
You must add the cost of dental insurance premiums with the deductible, copayment, and any fee left once the annual maximum is spent to calculate your total bill.
Waiting periods, maximum benefit per year, and whether you can see a dentist outside your insurer’s network are other factors that make a plan for dental insurance worth its costs.
Dental insurance allows you to potentially save money on out-of-pocket costs for oral health care. Like regular health insurance, you pay a monthly premium to guarantee coverage for at least a significant portion of your dental health care costs. Your dental insurance provider will pay part or all of your bills on your behalf, or reimburse you later.
Dental insurance plans will generally prioritize basic services that reduce your risk of needing costlier major services later, especially if you choose an HMO plan. The purpose of this is to reduce average costs to the insurance company.
In the US, about 30.1% and 28.5% of men and women, respectively, have dental insurance
Many people can access health insurance through their jobs, but you may be self-employed, out of work, or your employer doesn’t offer health or dental plans. Now, under the Affordable Care Act (ACA), you can purchase Marketplace health insurance plans alone or with dental coverage included. You may also buy dental insurance plans as stand-alone policies.
For example, let’s look at a hypothetical 30-year-old woman, with an annual income of $40,000 per year. She is not married and has no dependents. Her average premiums for the various dental insurance plan levels are $192 per month for Bronze, $270 per month for Silver, $315 for Gold, and $679 for Platinum. Dental insurance-only plans cost between $7.95 and $49.35 a month.
Dental insurance involves making regular payments to a fund that can cover your treatment costs when you need it, with the average dental insurance cost varying depending on covered services.
Dental insurance covers routine services such as cleaning, examinations, and minor procedures, and can even cover major services including surgeries and ongoing treatment.
Preventive care usually includes checkups and cleaning, with some dental policies listing sealants and fluoride treatments too. A number of services will only include children.
Basic services include fillings, X-rays, composites, crown repair, periodontal maintenance, and non-surgical tooth extractions. A dental plan will sometimes break these up into “basic” and “intermediate” categories, and the list of treatments will vary by plan.
Major services include restorative and orthodontia services, and may not receive coverage from cheaper dental insurance plans. Major treatments you can be covered for are crowns, inlays, onlays and pontics, fixed bridges, dental implants, complete and partial dentures, gold fillings, oral surgery including anesthesia, periodontics, and endodontics.
Orthodontic care, however, is often only covered by dental health insurance for children aged 18 or under.
Dental insurance options are differentiated by the levels of treatment they cover. All will usually cover preventative treatment and basic care, but many plans include major procedures such as crowns and surgery too.
Basic dental plans focus on preventive care and other basic services that can help you avoid more major treatment later. Teeth cleaning, checkups, X-rays, and some minor procedures such as fillings are included in basic dental coverage.
Minimum essential coverage may not seem like the best choice, but a large percentage of US adults skip dental care because of the upfront expenses. You also have lower average costs because a cleaning or minor filling results in lower dental bills than root canals, for example.
Full or comprehensive coverage includes major services, such as restorative care. However, these can have waiting periods before you are able to use them. If you are looking for a way to afford dental implants, they are unlikely to pay off overnight.
It is important to remember that full dental coverage does not mean that you have no out-of-pocket costs. You may still have an annual maximum limit, a minimum you must pay before your health insurance kicks in, and a percentage of care costs that aren’t covered even when you have reached that minimum.
The average cost of full coverage dental insurance plans is higher but covers more services. However, basic dental insurance options make prevention easier.
Many types of dental insurance plans vary in the services they cover. A cheaper dental insurance plan may only cover basic and preventative care, while some may only list orthodontic care under children’s benefits.
Dental insurance almost always excludes cosmetic procedures, unless they can be justified as having a medical purpose. For example, you may be able to claim crowns for an injured or decayed tooth, or an implant after an extraction, but not teeth whitening or veneers to improve the appearance of your smile. For the cosmetic cover, you may need to consider secondary dental insurance.
Some dental plans won’t cover major procedures, and almost all exclude treatment for purely cosmetic reasons.
Dental insurance is not a one-way ticket to unlimited dental services. You must add up the costs of your premiums and expected out-of-pocket expenses to see if the plan you are looking at is right for you.
Your premium is the cost you pay for health insurance, which may be a monthly, quarterly, or even annual payment. When comparing the costs of insurance, this is the first fee you see quoted. These are higher with more services covered or lower deductibles on your side.
Your deductible is your out-of-pocket expense for each treatment, before your insurance covers the cost. When researching dental insurance plans, compare the sum of your premium and expected deductibles to what you would otherwise pay without insurance.
The copayment is the portion you pay out of pocket, after you spend your deductible. You may see this quoted as your pre-set share of the costs for any covered service, or as a percentage of the contracted fee of your dentist.
Coinsurance plans are set up so that a percentage of the dental care costs are paid for by your insurance company, and the rest is your out-of-pocket costs.
A maximum allowance, or annual maximum benefit, is the total cost of dental benefits that your plan will cost for you or a family member per year. Ideally, you should not expect to exceed this unless unexpected costly procedures or major services turn out to be necessary.
Calculating costs with dental insurance involves adding together your premium and deductibles, plus any more out-of-pocket costs if you exceed the annual maximum.
The dentists you are able to visit and receive coverage for is determined by whether you decide on a Dental Health Maintenance Organization (DHMO), a Dental Preferred Provider Organization (DPPO), or an indemnity dental plan.
Purchasing a PPO dental insurance plan is the most popular option when it comes to private insurance. One of the advantages of a DPPO is that you can choose an out-of-network provider, because your dentist is paid by the dental insurance company based on the services they provide.
A DPPO may be the best overall option when it comes to choice. While PPO plans are often more expensive, you have coverage for a wider range of treatments.
Many people instead prefer a DHMO dental insurance plan because of its lower costs and no annual maximum. However, you are limited to only in-network dentists, who are covered because they signed a contract to work with the insurance company. You must also choose one as your primary dentist, who will then refer you to specialists if necessary.
The least common types of dental insurance, dental indemnity insurance does not have in-network and out-of-network practitioners. It is instead a traditional fee-for-service model. You must still consider the annual deductible, copayments, maximum annual benefit, and list of services covered.
The type of insurance you can choose is further split by whether you can claim coverage from out-of-network dentists, or if there is a network at all.
Getting the best value for money from your dental insurance plan requires looking at your needs, the dentist you want to see, the features you want, and the cost of full coverage.
The first question is what type of dental care you expect to need. If your dental health is relatively low-maintenance, you may prefer to focus on preventive care and basic services. This means you may benefit from lower monthly premiums.
If you or a family member requires orthodontic care, or you expect the need for major services in the future, higher premiums that reduce your annual deductibles could be more suitable. For example, you may be dissatisfied with your smile thanks to crooked teeth. Or, you may participate in extreme sports with a higher risk of needing a dental visit for restorative care.
The main difference between DHMO and PPO dental health plans is your access to dentists in or outside of their nationwide network.
If you don’t want a primary dentist, and prefer complete freedom of choice when it comes to the dentist you visit, a PPO plan is best. Even if your current dentist has signed to a DHMO, a PPO covers you if they decide to leave. Some dental insurance plans will list the same coinsurance rates after their deductible for both in- and out-of-network dentists.
Another key factor in choosing the right dental insurance plan is the services it covers, and how much coverage you get.
For example, one dental plan on the ACA Marketplace for the hypothetical Florida woman is an affordable $8.70 per month. After an individual total deductible of $75, she pays no coinsurance for routine dental care. While this may be low-cost, she doesn’t receive coverage for every service.
The list of routine services includes examinations, cleanings, and fluoride treatments. However, she cannot receive reimbursement for fluoride or sealants because she is over the age of 19. She gets one panoramic X-ray included every three years, and up to eight bitewing X-rays each six months.
Basic services are 50% covered after her deductible has been paid, but major services and orthodontia have no coverage. The major services list, including crowns, dental implants, periodontics, and surgery, require a 50% copayment. However, she must wait for 12 months before accessing this feature.
You can see how much your average health insurance or dental insurance plans will cost by entering your details on the US government’s Marketplace, an Affordable Care Act initiative designed to help citizens find the best insurance plans.
The hypothetical 30-year-old woman from Florida may be eligible for a full coverage dental health insurance plan worth over $40 per month in premiums. After a deductible of $50, examinations, cleaning, and X-rays are fully covered. Fillings, composites, pain relief, and pathology testing are classified as “intermediate” by the dental insurance company, and require a 10% copayment.
Low-cost dental insurance may only cover you for in-network dentists or basic and preventative services. However, you can save if you require major treatment and purchase a higher plan.
What are the most important things we need to know about dental insurance?
Your monthly premium for dental insurance varies based on the degree of coverage it provides.
Many dental insurance plans have no waiting period for preventive and basic procedures, but major dental procedures such as root canals and restorative treatment will often involve a six- or 12-month waiting period.
Dental coverage does not include cosmetic procedures without a medical purpose. However, a type of dental plan known as a Dental Access Plan will often provide discounts for cosmetic procedures, with no waiting periods.
Dental insurance costs are worthwhile, as they cover the preventive services that may prevent you from requiring major procedures later. They may also spare you from high unexpected costs in the event of an emergency.
Dental health insurance can potentially save you hundreds or thousands of dollars each year in oral care. More accessible preventative care and coverage in case of an unexpected emergency or other issue are greatly beneficial.
When researching your options, however, it is essential to read all of the fine print before making a long-term decision. Covered services, your monthly premium, copayment, annual deductible, and maximum benefit are all factors that affect whether a specific plan is right for you.