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Top FAQs About Choosing a Dental Insurance Plan

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Top FAQs About Choosing a Dental Insurance Plan

Colleen McGuire

Updated: March 14, 2019    Published: August 7, 2014


Who needs dental insurance?

Everyone should take a look at dental insurance coverage. Why? Because everyone needs preventive oral health care and everyone is vulnerable to significant expense from an accident, disease or the need for dental work due to an infection. Each of us needs to examine how much risk we’re willing to take to cover costs associated with dental health. 

What’s my level of risk without dental insurance?

Here’s an example of a procedure you probably hear about a lot: Damaged roots in a tooth become infected and need to be cleaned and filled via a root canal. After the root canal, the tooth often requires a crown. The cost of the root canal procedure will vary, based on where the tooth is in your mouth (molars are more expensive because they have more canals), and it depends on whether you’re treated by an endodontist or a general dentist. But the root canal can cost between $400 and $1,400, and the crown can cost another $500 to $1,500 – or even more – depending on the location of the tooth and the materials used for the crown. You need to ask yourself if you need protection from dental bills of this size.

Won’t my medical health insurance cover dental expenses?

Generally speaking, dental expenses are outside most medical plans. Even under certified plans under the Affordable Care Act, the only dental coverage required as “essential health benefits” is oral care under “pediatric services.” In other words, children are covered to some extent, but adults are not.

If you have a private health insurance plan through your employer, you need to examine it carefully to determine if your dental health coverage is adequate.

What about preventive oral health care?

When it comes to your mouth, a little prevention goes a long, long way. You’ll want to find a way to fund preventive cleanings and check-ups. There are established links between mouth health and body health. In one recent study, people with serious gum disease were found to be 40 percent more likely to have a chronic health condition on top of it. Because inflammation in the mouth can impact the rest of the body, conditions such as diabetes and heart disease have direct links to mouth disease.

What kinds of dental insurance plans are available?

There’s a wide range of coverage available. Most dental insurance plans, such as those provided through employers, usually provide coverage for some level of routine check-ups, as well as more extensive work, such as fillings and crowns. Often, there is one or all five of these elements in the coverage:

  • There may be a copay for appointments
  • You may need to be treated by an “in-network” provider approved by the plan
  • There may be a deductible which must be reached before coverage kicks in
  • There may be a “split” of costs between patient and insurer (often 50/50); and/or
  • There may be a ceiling on expenses covered for a particular procedure or for individual/family coverage for the year.

What will I pay for dental insurance?

Of course, premiums vary widely. But that also means that plans are customizable for your own needs. Cost will depend on many factors, particularly copay levels, deductible levels, covered services, coverage ceilings and more. In many cases dental insurance starts at less than $20 per month depending on your age and state of residence.

Is there coverage for expensive orthodontic work for myself or my children?

Coverage for orthodontics (the branch of dentistry dealing with the prevention and correction of irregular teeth, usually through braces) is widely varied. Some dental insurance plans have no orthodontic coverage. You’ll need to shop carefully if this is one of your priorities.

What about oral surgery?

Oral surgery is treated very differently among dental and medical plans. You’ll need to carefully examine plans to see what is and isn’t covered for oral surgery.




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