A brief look at dental health coverage and the different types of dental health insurance plans you can choose from.
Making decisions about your healthcare coverage is overwhelming. Along with sorting through your different options for types of healthcare plans, add-ons can further complicate the matter. One often-overlooked add-on: dental health coverage.
Effects of Poor Dental Health
Many people don’t realize the importance of purchasing dental health insurance, oral health often a mere afterthought for healthcare consumers. Says Michael Phillips, operations manager of Lux Dental Care in Cambridge, MA:
“Oral hygiene can certainly impact your overall health and wellbeing. Lack of proper dental care can even limit the types of things you’re able to eat later in life.”
Not only can poor oral hygiene affect your choice of foods and physical appearance, but it can also cause serious pain and even create a gateway for harmful bacteria to enter your body. According to the World Health Organization (WHO), oral diseases are the most common of chronic diseases.
Costs and Coverage of Dental Insurance
Still, given the steep cost of some oral procedures, it’s understandable that people tend to resist climbing into the dental chair. A standard checkup runs about $288 per visit, and procedures like fillings can sometimes exceed $1,000 per tooth. But, these high costs are greatly alleviated with dental health insurance coverage.
According to the National Association of Dental Plans (NADP), most dental health insurance plans cover 100% of preventive care. Even beyond preventive care, insurance typically covers 70-80% of basic procedures (fillings, root canals, etc.), and 50% of major procedures (such as crowns and dentures).
Embedded Versus Standalone Dental Coverage
Embedded Dental Health Coverage
Good oral health is essential to maintaining overall health for everyone, regardless of age. But, dental insurance is not one-size-fits-all. One option is “embedded” dental coverage, which means that dental care is part of your overall health insurance plan. Initially, this appears to be the simplest option, but there are downsides. The biggest disadvantage of embedded dental coverage is the high deductible. Most embedded plans use a single deductible for both medical and dental coverage; thus, if your deductible is $2,000, you won’t have any coverage for your dental care until you’ve already spent $2,000 on medical care that year.
Standalone Dental Health Coverage
On the other hand, you may choose a separate, standalone dental health insurance plan. A standalone plan has its own deductible, running no greater than a few hundred dollars (and typically much lower). Standalone plans also allow for more customized coverage to meet you and your family’s specific needs. For example, a family with young children may choose a plan with a slightly higher premium, but more coverage for procedures like fillings, because children are prone to cavities. In some cases, a standalone plan may be the best choice because the dental coverage offered with your general plan is more extensive than what you actually need.
4 Types of Dental Health Insurance Plans
Similar to the varieties of general health insurance, there’s a few different types of dental plans to choose from. These include:
Dental Health Maintenance Organizations (DHMO)
- Have the lowest premiums of all the types of dental plans; and
- Typically have no maximum cap on the number of services you can receive in a year. But,
- You’re required to see only dentists that are part of an HMO’s network; and
- If you seek care from an out of network provider, you’re likely to pay the entire bill out-of-
Dental Preferred Provider Organizations (DPPO)
- Similar to DHMOs, DPPOs have a list of providers for which they will pay the bulk of the bill.
- Unlike DHMOs, you can also see providers outside of your network and still have some of the cost covered (but not as much as you would with an in-network provider).
- Downside to this flexibility: DPPO premiums are higher than DHMOs; and
- There is a set maximum amount of services your DPPO will cover in a given year (but, keep in mind that less than 5% of consumers exceed this maximum).
(Despite the higher price tag, many consumers choose this plan. DPPOs comprise 82% of all dental coverage plans).
Dental Indemnity Plans
- Doesn’t have a network of providers, so you can see any dentist you like and receive the same amount of coverage as you would for another provider.
- Premiums are the highest of any insurance type;
- You’ll have to pay copays and deductibles; and
- You’ll also initially pay for services out-of-pocket, and then have to submit a claim for reimbursement from your insurance provider.
Discount Dental Plans (“Dental Savings Plan”)
This type of coverage isn’t actually considered insurance. It saves you money via a Costco-esque model, for which you pay an annual fee and subsequently receive services for a discounted price. The provider needs to be enrolled in the plan for you to receive a discount, and you ultimately pay out-of-pocket for your care, but there is no yearly maximum on services. There’s a choice of plans to fit different budgets, and more than 100,000 providers are enrolled in the plan.
Although the choices can seem overwhelming, it’s worth it to purchase dental coverage for you and your family. By investing in preventive care now, you’ll avoid the need for procedures down the line, saving yourself thousands of dollars in the long run.
The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com.