There are more dental plans than you can throw a stick at, and it can be overwhelming to decipher the nuances of each one. The last thing you want to do is buy insurance that will end up causing more harm than good.
We want to help clear up some of the confusion. This article breaks down the different types of dental insurance companies out there and what each one offers.
Dental insurance may seem like a necessary evil but can offer significant benefits.
There are five types of dental insurance that cater to different needs.
Dental services are broken down into four distinct categories depending on their severity.
Orthodontic insurance can be a crucial investment for those looking to straighten teeth.
No dental plan is perfect, and it is essential to weigh the pros and cons of each one.
Personal dental care in the home can go a long way toward preventing unexpected mouth issues.
There are five types of dental insurance:
A dental HMO is essentially a prepaid plan that offers affordable coverage for preventive care. Services covered with no out-of-pocket cost often include bi-yearly exams, cleanings, and X-rays with in-network dentists. There’s usually no deductible and a set price for non-preventative care. Participating dentists are able to give members discounted fees because the dental insurance company pays them a set amount each month.
These types of dental insurance rarely have annual maximums for covered services, so there’s no need to worry about maxing out your care. You’re able to choose your own dentist from within a network of providers within a dental HMO, but this list can be pretty limited. However, keep in mind that even basic services are not typically covered if you choose to look for a dentist outside the DHMO’s network.
Similar to DHMOs, dental preferred provider organizations list a network of providers to choose from. This network is more extensive than a DHMO, and you’re not required to select one dentist for all your care. As a result, dental PPO plans offer more flexibility when planning for preventative services or basic care. This dental plan does have an annual maximum that you’ll want to be sure not to go over. It is the most popular type of dental insurance available.
Dental PPOs do often come with an annual deductible that you must meet before your dental insurance plan starts to help out. Once satisfied, you’ll still pay out a reduced fee for restorative care and major services. The annual deductible may be waived for preventive services such as cleanings. These dental insurance plans will still pay toward out-of-network providers, but at a lesser rate.
You can think of a dental exclusive provider organization as a beefed-up dental PPO. The dental plan offers comprehensive coverage and provides little to no out-of-pocket costs for a majority of the dental procedures out there. This includes things like major restorative care, root canals, and even orthodontic services. These dental plans have annual maximum amounts you’ll need to watch out for.
Such insurance plans come with an annual deductible, and you may need to pass through waiting periods before you can schedule certain otherwise covered dental services. There is no need to obtain a referral for a specialist when scheduling your dental care. Except for select emergency services, DEPO insurance plans won’t cover even basic services when you head out of network.
A dental POS plan mashes together some of the best features of DHMO and DPPO types of dental insurance. Here, your insurance company will make you choose a primary dentist who will be your point of contact for referrals. However, you are not limited to seeing this provider for preventative care or other services, and you can shop around as you desire.
These dental plans allow the ability to go inside or outside their network for dental care, but out-of-network services incur more out-of-pocket expenses. Such flexibility typically comes with the cost of higher copays and deductibles.
More of a traditional dental insurance plan, dental indemnity is often referred to as “fee-for-service” coverage. These dental policies have a deductible that you’ll have to pay toward until you meet. At that point, the insurance company will start helping cover your costs. These rates vary from plan to plan.
There’s no network for such plans, and you’re free to go wherever you want for your dental care. Depending on your dental benefits, you may not even need a referral to see a specialist.
There are five types of dental insurance available to choose from. Plans range from low cost and minimal flexibility to more expensive plans that offer greater options and freedom.
Dental insurance can give you the boost you need to pay for anything from preventative care to major services that can keep your smile as healthy as possible. It works similarly to health insurance, with a premium that you’re contracted to pay each month. There’s also usually a deductible amount that you must clear before any insurance provider will begin paying. However, there are a few notable differences between the two.
Dental insurance premiums are typically quite a bit lower than health insurance plans. The caveat here is that health insurance providers pay a vast majority of medical bills once your deductible is covered, and often list a maximum amount you’re obligated to pay. Dental insurance companies, on the other hand, usually follow a specific billing structure.
While dental plans should cover preventative care, they pay out a smaller percentage the more complex the service becomes. On average, dental insurance companies pay out 80% for basic care such as fillings and simple tooth extraction. When it comes to major services like crowns or dentures, that amount drops to only 50%, leaving you with a bill for the other half [1].
It’s even possible to have two dental insurances if your spouse’s employer also offers coverage or you add additional coverage. In these cases, one plan is labeled the primary while the other becomes secondary dental insurance. The primary will pay out first, and a secondary plan can cover some of the remaining expenses.
The New England region had the highest rate of dental coverage among adults at 57.1%. This was followed by the Middle Atlantic region at 55.8%
Dental insurance companies require monthly premiums and deductibles before they are able to be used. Plans typically entirely cover preventative services but aren’t as generous with more comprehensive procedures. Secondary coverage can help offset some of the costs of a primary plan.
Dental insurance plans break down coverage into four categories:
Class 1 represents preventive dental care, such as X-rays, exams, and cleanings. Dental plans almost always cover these basic services at 100%.
Class 2 services encompass basic restorative care work. Types of basic procedures relating to class 2 include fillings and root canals. Although not major, these services may require some out-of-pocket costs depending on your dental benefits.
Class 3 involves major restorative care on teeth or gums. Examples include crowns, dentures, and dental implants. Some dental plans may not cover major services or will pay significantly less than towards basic services.
Class 4 covers anything that doesn’t fall into the first three classes. This category is for the unknowns that come with patients who have not received dental care in at least 13 months.
There are four categories that dental services fall into. The services for each subsequent class increase in severity and complexity.
Standard dental insurance rarely covers any sort of orthodontic care unless it is considered medically necessary. For braces and other tooth-straightening procedures, you’ll want to make sure your dental plan has orthodontic insurance.
Orthodontic insurance packages come as subsets to some dental insurance plan levels. These packages offer a means to save money on the long-term cost of using bracers or aligners. As you check out what’s available to you, verify which orthodontic services are covered and at what percent. It’s crucial to make sure the added cost of orthodontic coverage outweighs the premium on your monthly payment.
Even if you have coverage for braces, insurance companies may place annual limits on what you can spend, lifetime maximums, or there may be waiting periods before you can begin or continue treatment. Insurance companies consider braces for children very different from braces for adults, so look carefully to avoid surprises down the road.
Four types of dental insurance can cover orthodontic care:
DPPOs are by far the most common dental plans available, and more and more companies are adding options for orthodontic care. These are usually supplemental fees to the standard premiums these plans have.
Since orthodontists are considered specialists, you’ll likely need a referral from a dentist before you can pursue treatment. With such similarities to DPPOs, DPOS plans are known to provide similar options.
Both DEPO and dental indemnity plans can offer advanced coverage for orthodontics and may not even require a referral beforehand. As with all plans, you’ll want to verify what’s covered before signing on the dotted line.
Invisalign produces a line of invisible aligners to correct mild to severely misaligned teeth in teens and adults. Their products require the recommendation of a dentist and routine visits in an office.
Dental insurance plans that offer coverage for orthodontic care may extend to cover a portion of Invisalign’s program as well. The best you’ll find will only knock about 50% off the total package cost, but even this can go a long way.
All types of dental plans can cover these major services, but at varying levels. Dental savings plans may completely cover preventive care but pay out very little on a complex procedure.
Dentures, crowns, and bridges are all major services that require a full coverage insurance plan. These plans include preventive care while covering a slew of extras. Major services come with hefty price tags, and full coverage doesn’t mean you won’t have anything to pay. Also, don’t forget about any annual maximum amounts your plan might have.
No, there’s no insurance company that’s going to cover every imaginable service, treatment, or procedure at 100% of the cost. Even if it did, the premium or deductible would be incredibly high.
No, there are dental insurance plans out there that will cover even major procedures right out of the gate without the need for waiting periods. These plans without waiting periods often come at the cost of higher monthly premiums or elevated coinsurance fees.
Here are a few of the most commonly asked questions surrounding dental insurance plans.
Dental insurance is a cost-effective way to maintain healthy gums and teeth through checkups and other preventive measures. It can also offset the cost of basic and more severe services that can lead to permanent or long-term problems.
PPO plans are the most widely used by far, but each type of insurance has merits that should be considered. Within a plan type are several options, from basic services to orthodontic care that may prove useful depending on your specific need.
Whatever insurance plan you go with, be sure to study the fine print of what is covered and what isn’t. It’s also important to understand fee schedules so you’re not left with sticker shock after receiving a bill.
