We can all agree that finding the right health coverage plan is a confusing, meticulous wade through mountains of fine print. It’s even harder to find a dental plan, but there are things to watch out for so you don’t get caught without the best oral health care.
Let’s look at how health insurance is categorized by the US government’s Affordable Care Act tools, and what it all means for your dental coverage.
Health insurance plans are categorized into metal plans by the Affordable Care Act to conveniently depict their benefits.
Metal plans are grouped by the average percentage of your fees they cover, not typically the range of services.
Despite the convenient ranking system, it’s best to research the health insurance Marketplace to compare what each plan covers and your total costs.
If you cannot find an insurance company with a plan that meets your needs on the US government search tool, you can still research other options for families and businesses.
Other dental plans may have a different structure regarding pricing and services covered, but will follow a similar tiered system.
Classification of dental plans by metal level is one measure made to boost uptake of Marketplace health plans. These are the insurance plans provided by The Affordable Care Act that aren’t provided by employers.
Bronze, Silver, Gold, and Platinum categorize health insurance by the plan’s contribution to the total care fees. They have the same essential health benefits and quality of care, but different out-of-pocket costs and premiums. The remaining out-of-pocket fees include your deductibles, coinsurance, and copays, so these figures are only averages.
You can expect the Bronze plan metal level to cover 60% of your health care costs, while you pay the remaining 40%.
On a search made for a hypothetical 29-year-old woman in Broward County, Florida, who lives with others but has no spouse or dependents and has an income of $40,000, the average Bronze premium was $192 per month if she had no eligibility through her job.
Not all of the woman’s options for Bronze health plans included adult dental care. One that does include it, however, covers a wide range of services with no out-of-pocket fees for checkups, X-rays, or routine prevention. Most fillings had a copayment of under $100.
A Silver plan level of insurance will cover 70% of your care costs. The hypothetical young woman’s health plan would carry an average premium of $269 per month here.
Not all Silver plans include adult dental care. Of the Silver plans that did, one choice for the young woman only covered routine dental services, with no basic, major, or orthodontic procedures. Another Silver plan offered the same coverage as the Bronze plan described above, as they are provided by the same insurance company.
Gold plans are another step higher, and will pay 80% of your average bill. For the young woman, this level of health insurance would cost an average of $313 per month. Of the Gold plans including dental services, one applies a $1,000 annual maximum, while another provides the same list as lower-level plans.
Platinum is the highest level and this health plan covers 90% of your health care fees. Here, the young woman’s available monthly premiums cost an average of $672 each month. No platinum health insurance plans included adult dental care, however.
Some people have access to an additional “Catastrophic” level. These have higher deductibles but lower premium costs. The coverage provided is less than 60% of your dental services’ fee, but this level serves the purpose of reducing dental or medical costs when your financial situation doesn’t fit regular payments for bronze, silver, gold, or platinum plans.
The hypothetical young woman above had minimal options for Catastrophic plans. After being entered as not being eligible for a health insurance plan through her job, one plan appeared on the seventh page when results were sorted by cost. They are not necessarily cheaper. You must research the complete details before deciding which level of coverage is the most cost-effective.
Another example of a Catastrophic plan described by the DHHS is the BlueChoice HMO Young Adult Plan. It is only available to young adults who are under 30 on the effective date. Exceptions can be made for those 30 years old and over if they have a hardship exemption, or non-compliance with the Affordable Care Act forced the cancellation of their policy.
Metal levels are named based on their premiums and coinsurance amounts, but their level of dental coverage may not rise along with healthcare.
Dental plans available on the Marketplace are categorized into High and Low coverage levels. You can expect higher monthly premiums with High coverage, but you will pay less in deductibles and copayments. Low levels mean lower monthly premiums, but you pay more in expenses such as deductibles. But how do we know if the dental insurance cost is worthwhile?
The most affordable coverage for you depends on how much you expect to use your health insurance plan. A lower monthly premium is likely best if you anticipate only requiring preventive and basic services. A higher monthly premium may lower your total average costs if you expect to need major procedures such as implants or orthodontic care.
Whether a high or low coverage level is worthwhile depends on what you could expect to spend on dental fees.
In the Marketplace, most companies offer both dental and health insurance. As part of the Affordable Care Act, the US federal government has constructed a search tool for you to find health insurance plans based on your location, income, and other factors. The health plans that apply to you are ranked by Bronze, Silver, Gold, and Platinum levels too.
Unfortunately, dental care for adults is not seen as an essential service, although it is for children. Some high-level health plans don’t include dental care at all. Other health care plans may only cover child dental care, and those that do offer dental coverage for adults sometimes offer little more than the most basic of services.
In the Department of Health and Human Services’ Marketplace, you usually cannot buy a dental plan without a health plan. There are a few options, however, but they carry a separate premium. The hypothetical young woman has 216 options for health insurance, but only 35 choices for dental plans on the Marketplace search tool.
The US government makes searching for insurance plans simpler, but not everyone’s needs for dental insurance are met by their search tool.
Besides the DHHS Marketplace, you can search for other dental plans independently. Their plan categories are typically given different names, and higher levels may cover more treatments. These can include major procedures such as orthodontic care and out-of-network services, particularly the PPO dental insurance plans.
Bronze plans solely for dental insurance may be sold under names such as the Starter Plan. One example of a Bronze Starter Plan available online offers 100% coverage for preventive care, and 50% of basic care costs after a six-month waiting period. Major care, implants, and orthodontic treatment are not included, and there is a $50 deductible for out-of-network dentists.
Those resembling a Silver level plan could include benefits for more types of procedures. For example, you could expect 80% coverage for prevention and 50% for basic services, and 50% coverage for implants and major procedures.
A level similar to the Gold plan may provide “free” preventive care services, and coinsurance plans including 70% coverage of any basic services. You may also have 50% coverage for implants, major procedures, and orthodontic care, but there can be age limits for orthodontic procedures.
One example of coverage levels similar to a Platinum plan lists full coverage for preventive care services and 80% for basic care. This is alongside 50% coverage each for implants, major procedures, orthodontic care, and teeth whitening. However, there is still a $50 deductible to pay for all services except for preventive care by in-network dentists.
You can search for dental insurance outside the DHHS-built search tool, but research carefully as different terminology and inclusions are common.
What are the most important things to know about how to choose a dental insurance plan with metal levels?
Plan metal levels categorize health insurance by premiums and the share of your average healthcare costs that you can expect to be covered.
The metal system of health plan categorization was designed for the Affordable Care Act to clearly define Marketplace plans. They are named after metals with commonly known values, to give a general idea of what to expect from them.
The four most common levels are Bronze, Silver, Gold, and Platinum.
Insurance plans with high metal levels cover up to 90% of your expenses, but have higher premiums. If the dental coverage for your health plan is categorized as High, you may have a broader range of services covered with lower copays.
The metal level system of categorizing health insurance premiums and coverage is a helpful guide to estimate each plan’s costs and benefits.
However, when deciding whether your dental insurance reimbursement will be worth the premiums and other costs, it’s not enough to go by metal levels alone. Sometimes, higher levels may have lower premiums, or on the other hand, they may not cover dental care at all. Thoroughly researching your options is essential.