Get All Of The Facts On Dental Insurance

What is dental insurance? You may have asked this question while researching your options for affordable healthcare. Dental insurance can be difficult to decipher thanks to various nuances that differentiate it from traditional medical insurance. In the following article, we’ll give you the basic facts about dental insurance including what it covers, what it costs and how to get it.

What Dental Insurance Covers

For the most part, dental plans are created to promote preventive care over treatments. Insurers know that most people will take care of their teeth at home and through regular checkups, so the impetus is low to provide in-depth coverage for intensive dental work. Still, many plans do cover at least some portion of major dental work as well as routine services. Dental plans recognize the following classes of service:

  • Class I: Class I involves preventive care such as diagnostic X-rays and semi-annual cleanings. Most insurers will cover the cost of class I services at 100 percent.
  • Class II: If you need a filling or a root canal, this counts as a class II service. Dental plans cover these procedures at 80 percent.
  • Class III: More in-depth dental treatments such as bridges, dentures and crowns qualify as class III services. Dental carriers usually only pay about 50 percent of these costs.
  • Class IV: Class IV refers exclusively to orthodontic care such as braces for your kids. In most dental plans, there’s a strict limit on the dollar amount paid for these treatments, and you most likely can only get orthodontia for your kids.

While dental insurance covers many of the services that you’ll likely need, you should note that most dental plans also place restrictions on certain types of treatments and the frequency of your treatments. Here are a few things to keep in mind:

  • Most dental plans cover a limited amount of orthodontic care. If you’re an adult, you may not be able to get treatments such as braces covered by your insurance carrier.
  • The “missing tooth clause” prevents beneficiaries from receiving restorative care treatments for lost or missing teeth that existed prior to the date of coverage. In other words, if you’re buying insurance to fix a problem you’ve had since birth, then your insurer may not cover it.
  • Some dental plans include a 12-month waiting period for certain dental treatments. This means that you may have to pay for dental insurance for a full year before you can start receiving benefits.

Dental insurance also places an annual limit on the amount a carrier will pay for treatments. In most cases, your cap will range from $1,000 to $1,500 per year, per beneficiary. Once your insurer pays this maximum amount, you’ll be responsible for any additional costs associated with your dental care. If you need a lot of expensive treatments, then you should shop around for plans that offer higher maximum payouts.

Different Types of Dental Plans

There are three different types of dental plans in the United States. No plan type is inherently better than any other type, but there are advantages and disadvantages to each. When shopping for insurance, you’ll likely come across the following plan types:

  • Dental Preferred Provider Organizations: Also referred to as a dental PPO plan, the preferred provider organization plan offers good flexibility when it comes to providers and payout allotments. In this type of plan, you can choose your provider, but you’ll save money by choosing an in-network provider. Within the network, you’ll pay a set rate according to your policy. Insurers typically follow a “100/80/50” rule: 100 percent coverage for routine care and cleanings, 80 percent coverage for root canals and fillings, and 50 percent coverage for in-depth treatments.
  • Dental Health Maintenance Organizations: DHMO plans restrict members to in-network providers, and you have to visit your primary dentist if you need a referral to a specialist. However, there are some advantages with a DHMO plan. For instance, these plans offer higher annual payout maximums, which can save you hundreds of dollars on dental care.
  • Indemnity Plans: Dental indemnity plans offer the greatest flexibility in terms of provider choice. With these plans, you don’t have to worry about a network of providers, which is a relief for those whose dentists don’t participate in a certain network. Indemnity plans usually are offered through employers.

You can also buy a dental discount plan, but this doesn’t qualify as insurance. Instead, it’s a discount system that allows members to receive treatments at a reduced rate. Most dental insurance plans do not cover cosmetic treatments, and some don’t cover certain elective options even if they seem necessary. Dental discount plans can be used for any dental treatment, but it’s not the same as having insurance.

Average Cost of Most Dental Insurance Plans

The cost of a dental plan varies according to location, carrier and the type of plan as discussed above. Dental premiums cost much less than medical premiums do, but dental insurance doesn’t offer the same level of coverage. Here’s a breakdown of the average costs for each type of dental plan:

  • Dental PPO plans are flexible insurance plans, and they come with a higher price tag than DHMO policies. Plans average around $25 a month for most people, but you may be able to get a better rate if you’re willing to give up some coverage options. Keep in mind that a PPO lets you choose your provider, but you will pay more for out-of-network doctors regardless of your premium.
  • DHMO plans cost less than $20 a month, and some can cost significantly less than this. In 2011, for example, the average cost of a DHMO plan was around $13.50. These plans are designed primarily for preventive care, which means that they’re a good option for people who need few dental services throughout the year. However, you may not get great coverage with a DHMO plan when it comes to more invasive procedures.
  • Indemnity plans are even more flexible than PPOs, which means you’ll pay the most for these plans. The average monthly premium is about $40, but indemnity plans may not be available to you outside of an employer-sponsored plan.

Cost is relative when it comes to insurance. Different carriers in your state may offer more competitive rates depending on your needs. For example, Blue Shield of California offers an example of how dental insurance might save you money during a regular year, but your situation may differ. Before you commit to an employer’s plan, research your options in the private sector and the government marketplaces because you may find a better deal.

Options for Buying Dental Coverage

Many people with dental insurance buy their coverage through work, but you don’t have to choose your work’s policy if it’s not what you need. You have several options for getting dental insurance.

  • Private plans: Major medical providers often offer a dental plan that’s separate from their medical insurance policies, but you can also find dental-only plans and carriers throughout the United States. Working with an insurer directly can be more beneficial for some people, so don’t hesitate to check out your local options.
  • Employer-sponsored plans: Larger companies typically offer dental and vision as an optional supplement to medical plans, and some even offer an all-inclusive package that includes coverage for all three types. If you just want the medical coverage, you can forgo dental and vision. If the plans work for you, however, you may find that employer-sponsored coverage is cheaper than private options.
  • Government plans: Under the Affordable Care Act, you’re not required to purchase dental insurance. However, you have the option to buy dental coverage on state or federal marketplaces. To use this option, you will need to buy medical coverage on the marketplace as well.

Buying dental insurance can be a good investment, but it’s not necessarily an expense that many people choose because the benefits don’t always outweigh the cost in some situations. Evaluate your dental needs thoroughly to determine if dental insurance will work for you.