Dental Insurance- Coverage, Plans & Options

Dental Insurance

Dental insurance is used to take care of some or all of the costs that are associated with your dental services.

Because dental care and health care services can be costly a dental insurance plan helps offset some of the costs associated with treatments or procedures making them easier to afford and helping you to save your money.

Dental Insurance Coverage

There are a lot of different dental insurance plans available and before choosing the one you’ll need to decide what type of dental coverage you require.

You will need to compare dental plans and decide which one is right for your healthcare needs and budget. The two main types of dental coverage are HMOs and PPOs:

Health Maintenance Organization (HMO) – A HMO plan requests that you choose a dentist who belongs to the network of providers set forth by the HMO.

This dentist will give you primary dental procedures and will be the one that will refer you to a specialist in the event you need additional care.

Preferred Provider Organization (PPO) – A PPO lets you go to any dentist you choose although they may offer more discounted rates if you choose to use a dentist within the PPO network.

Both HMOs and PPOs allow you to save money on your dental fees such as dental cleaning and check-ups and often include these for free.

You can also expect to save on common procedures such as dental fillings or restorative dentistry procedures.

Cosmetic Dental Procedures & Insurance

Cosmetic dentistry procedures are not usually covered by dental insurance plans because they are generally elected as opposed to required.

There may be situations that arise that a treatment that is commonly referred to as cosmetic can be billed as a restorative procedure.

The best advice for patients seeking to be reimbursed for cosmetic dental procedures is to ask your dentist’s financing manager about costs and coverage prior to consenting to and receiving treatment.

Alternatively, your cosmetic dental coverage may be provided by discount dental plans. Discount dental plans can cover 15 to 20 percent of cosmetic dental costs.

Dental Insurance Plans

Before selecting a dental plan you should know that there is no one-size-fits-all type of coverage. There are some factors that should be considered including:

  • the type of treatments you and your family are planning on receiving
  • how often you visit the dentist
  • how much emergency care you require
  • how much dental work you think you’ll need

If you have an existing dentist then you’ll need to find out if your dentist accepts the plan you want to get.

Again this is where it pays to build a relationship with the financial manager at your dental office so that they can give you input and give you recommendations depending on your needs.

Dental Insurance Plans Available

In addition to HMOs and PPOs which are classified as managed care plans, the other major type of dental insurance is an indemnity plan.

There are advantages and disadvantages to each that depend on the nature of care you need.

Indemnity Dental Plans

Indemnity dental insurance plans allow you to choose your own dentist and require the client to pay for dental care up front before being reimbursed by the dental insurance provider.

The dental insurance provider will reimburse you for all or part of your dental care, depending on the terms of your plan.

These plans may also limit the number of services covered within a given year by placing an annual dollar limit on benefits.

Managed Care Plans

Managed care plans are known for their low costs that are a result of choosing a dentist within the network. The more popular of the managed care plans include:

PPO– PPO plans allow you to choose your dentist and include monthly premiums, an annual dollar cap, and an average monthly cost of about $20 to $25.

HMO– For HMO coverage you will have to choose a dentist within the network to receive benefits.

Dental Plan Options & Considerations

There are more dental insurance plans than the ones mentioned above and it is recommended that you research the various options available to you.

If you are new to dental insurance you should find out what services will be covered by the policy and what the limitations of the plan are. Some considerations to examine are:

  • how much the deductible will be
  • how long must you wait until the policy starts to cover certain procedures
  • what the annual maximums are so you know how much coverage you have prior to coming out of pocket