Dental Insurance 101: Choosing the Right Plan for You

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Dental Insurance 101

According to the Centers for Disease Control and Prevention, 25% of adults have untreated dental cavities in their permanent teeth. It is such a worrying figure because cavities in permanent teeth can lead to several dental diseases. Unfortunately, problems with your teeth can also affect your general health and well-being. What’s even worse is that most of these people could visit a dentist, but they don’t. The reason they won’t go to the dentist is that they can’t afford to pay for dental treatment. Lucky for them (and for you), we’ve got the go-to Dental Insurance 101 guide below.

There is an option that can help them get the treatment they need without having to pay all at once or go into debt. Dental insurance allows you to pay a discounted price for dental procedures. You have a set fee schedule for the premium payments, and the insurance company usually collects those premiums every month.  

Dental insurance can be added to a comprehensive health insurance plan or be taken out as a separate plan. Bear in mind, however, that like all types of health insurance, there are going to be limitations. Each program will also have its own payment schedule, a network of dentists, and coverage levels.

Before looking at dental insurance in more detail, let’s discuss some of the terms you’re going to encounter when shopping for a policy. It helps if you know what everything means when you’re doing your research.

Dental Insurance 101: Terminology You Need to Know

Deductible 

This refers to a determined amount you have to pay before receiving any benefits. Most dental insurance policies require a deductible, which they disclose in the plan terms.

Copayments 

As with health insurance companies, most dental insurance companies use that term a lot. Some programs make you pay a fixed-dollar amount for specific procedures. When you sign up for one of these plans, the insurer will let you know what services require copayments, and which ones are paid in full by the company. 

Annual Maximum 

This is the amount of money you’re allowed to spend at a dental practice each year, and have insurance pay for it. Not all programs have this provision. You need to ask your insurer if they have the type of plan that features an annual maximum or uses some other kind of limitation. A lifetime maximum is another term that companies often use, and this refers to the total amount of money the insurer will pay over the lifetime of your plan. It’s handy to know this because you can make a long-term assessment of how valuable this insurance plan really is. 

Open Access 

Some plans allow you to visit any dentist you want without having any coverage restrictions. Bear in mind, however, that a network dentist will be cheaper to visit. That’s because network dentists have agreed on a price for their services with the insurer.

Closed Network Plan 

This is the opposite of the previous term. With these plans, you have pre-selected dentists to choose from, who have pre-determined prices and fees. If you prefer to visit a specific dentist, find out whether they are part of a particular dental insurance network before purchasing your plan.

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How Does Dental Insurance Work?

Most people tend to confuse the way that health and medical insurance works. They have huge expectations regarding the coverage provided by their insurance. Often, they expect to have protection against anything that happens, even if that means they need an expensive medical procedure. The same happens with car insurance or health insurance. In reality, it’s not like that at all with dental plans. In the case of dental insurance, your coverage will be valid for minor and preventive procedures.

Some dental insurers will allow you to sign up any time during the year. In other words, there’s no “open enrollment period” for getting a dental insurance plan. Different types of policies, such as life insurance and health insurance, do have this period. 

Once you apply to a particular plan, you need to wait a pre-determined period before using it. The waiting period varies depending on the insurance plan you choose, but it usually lasts for six months to a year.

Dental Insurance 101

Double Dental Insurance

There’s also the possibility of having double dental insurance. However, don’t think that means you get double coverage. For example, if you have two x-rays a year covered with each insurance plan, it doesn’t mean you’ll be able to have four x-rays a year. The two insurers would provide different coverage levels: one would be your primary dental insurance, and the other one a secondary plan.

A primary dental insurance policy covers the costs as if there were no other insurer. The secondary one acts as a supplement. That plan only covers minor out-of-pocket expenses that you can not include in your first plan. How the primary insurance is selected depends on where you have signed up for your coverage.

Different Types of Dental Benefit Plan

There are two types of dental insurance. Each of them has different characteristics and plans you can choose. Which one you choose depends on how much you want to spend, and what type of coverage you need.

Type 1 – Commercial Insurance Carriers

Dental Preferred Provider Organization (DPPO or PPO)

PPO dental plans are one of the most common types of dental insurance in the US. This type of policy covers dental work undertaken by a network of dental practices. You can also use the services of another dentist out of the network, but it’ll be a little more expensive. Generally speaking, these plans work with a deductible system and coinsurance. Your insurer pays a percentage of the costs, and you pay the rest.

Dental HMOs

This type of insurance is very similar to PPO dental plans. You choose a dentist and start receiving dental care. However, this type of insurance doesn’t cover any of your expenses if you use an out-of-network dentist. It’s common to see this type of insurance in employer-sponsored dental premier plans. Individuals don’t tend to choose this service since there’s no annual benefit maximum. Instead, individuals usually choose a copayment-based policy.

Dental Indemnity Plans 

Historically, these have been one of the most popular plans. There is no network restriction, which means you can visit any dental office you want. You pay a pre-determined percentage of the cost to the dentist, which is calculated based on the average amount charged by a dentist for a specific procedure. If you go to a dentist that charges more, you have to pay the difference. This type of plan has an annual benefit maximum and deductible system.

Discount Dental Plans 

When there is the word “discount” added to the name, people tend to get confused. They believe that dental insurance plans and a dental discount plan are a different product type. However, based on how a discount dental plan works, they’re just a sub-type of dental insurance. The difference with a discount plan is that you don’t have to pay any coinsurance, and the dentist gives you a predetermined discount for any minor procedure.

Another difference is that there is no waiting period after you buy the discount plan, and you can use it right away. There’s also no monthly payment, but instead, members pay an annual fee, which usually varies from $120 to $150. There is one disadvantage, however: You aren’t able to choose your dentist. Instead, you only have access to those participating dentists of the scheme.

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What Does Dental Insurance Cover?

Dental insurance usually only covers minor procedures and preventive dental care. But what exactly does that mean?

  • Preventive procedures – the whole point of dental insurance is to maintain good dental health. Therefore, most of the dental services covered are preventive procedures, such as x-rays, examinations, and cleaning.
  • Basic procedures – other dental coverage can include extractions, periodontal work, and fillings.
  • Complex procedures – most dental insurance doesn’t cover complex procedures such as root canals, crowns, bridges, dentures, or implants. However, some dental insurance plans do. In these cases, the insurer offers it along with a copay. This means the company will cover a specific percentage, and you have to pay the rest.

How Much Does Dental Insurance Cost?

A report from the Associated Press shows how the cost of dental care has increased over the past few decades. The statistics also show that prices will continue to rise by 5% annually. It comes with no surprise why so many people are looking to buy dental insurance. But, is it something that will help you save money? Let’s help you figure that out.

There are two ways you can pay for dental insurance, either a monthly or an annual plan. People usually pay from $15 – $50 a month, or up to $360 a year. Most of these plans have a maximum yearly benefit, which varies from $1000 to $2000.The main difference between health insurance and dental insurance that there are no surprises. Buy insurance through the health insurance marketplace, and you will get a bill after you’ve received the treatment. With dental insurance, you pay a predetermined amount for each visit.

Some people think that getting dental insurance is unnecessary. But, according to a survey from the Consumer Reports National Research Center, the amount of money you save on out-of-pocket expenses is considerable. The out-of-pocket cost of a root canal procedure can cost $1,201 without dental insurance. If you’ve got dental insurance, the out-of-pocket costs can be as little as $593. If you’ve paid less than $500 for your dental policy that year, you’ve already saved money. 

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Tips on Choosing Your Dental Insurance Policy

Everyone needs to consider deductibles, copayments, and in-network providers. Nevertheless, it can be quite confusing to choose dental insurance. There are so many ins and outs of dental coverage, and a large number of policies to choose from. It won’t be so difficult if you consider the following tips for deciding what you need.

Your Dental and Health Habits

The first thing you need to think about is whether your oral health habits are good or bad. If you have good dental practices, then you won’t need to have many procedures during the year. You might only have to visit the dentist a couple of times for cleanings or x-rays. Knowing your dental health status is going to help you determine which plan will work best for you.

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Deductibles

Another good thing to do is try to find a deductible that fits you. If you don’t have many requirements for your dental care, then you don’t need a high deductible. If you are a picky person when it comes to choosing your dentist, a high-deductible plan won’t suit you. You do need to know, however, that when you pay a low deductible, the monthly premium is higher. It’s essential to ensure that the premiums are within your budget.

Type of Insurance

Decide what kind of insurance you want. Remember that DHMO plans are a good option when it comes to saving money. You don’t need to be able to cover a deductible to start enjoying the benefits of this plan. However, you won’t have many in-network providers to choose from. If you want a big pool of dentists, we recommend you choose a PPO dental plan. You’ll have a significant dental network, and you can even select a dentist out of the network. The disadvantage of having a PPO plan is that it’s a little more expensive than other types.

Choose the Right Premium

How much you have to pay depends on how much you want to spend every month. Consider also for your monthly bill, how many procedures are needed to keep your smile looking healthy. If you know your dental health is decent, go for a cheap plan of around $15 a month. It won’t cover unnecessary expenses, but you can still get the treatment you need. However, if you think you’ll need more dental services, paying a higher premium for better benefits may be the right choice.

Dental Insurance 101

How Long is the Waiting Period?

Is the waiting period too long for you? Many plans require you to pay premiums for several months before you start using them. The reason for this waiting period is to prevent people from buying dental insurance, getting dental treatment, and then canceling the policy in a short time.

When people do this, the company incurs unnecessary expenses that they struggle to make up for through premiums. When you’re looking for a plan, spend some time thinking about whether you want to use the plan soon, or you don’t mind waiting a while. If you don’t want to or can’t wait, there is always the option of buying a discount dental plan.  

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The Big Takeaways

There are so many good reasons for you to purchase a dental insurance plan. According to the National Association of Dental Plans, over 205 million people in the U.S. are enjoying dental insurance benefits. The key to choosing the right plan is knowing what is best for your family and its dental care needs. There are plenty of insurance companies offering excellent coverage for a low price. Now you have all the information you need to make an informed decision.  

With the health of your teeth playing such a vital role in your general well-being, there’s no time like the present to get coverage. It’s possible to sign up with an employer-sponsored dental plan or choose an individual policy that fits your needs. 

We’d love to hear how you found the best dental plan for your needs, and whether your experience has been a good one. We hope the information provided has helped in your search. 

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