Dental insurance can help you and your family save money on oral health services each year. It can provide access to free cleanings and possibly even no-cost sealants for the kids, which is usually worth the premium. However, choosing the best coverage isn’t always as simple as picking an affordable plan from a familiar insurance company.
You can pick the most budget-friendly dental insurance and wind up with less coverage than you need—or choose something robust that you don’t use, which means wasted dollars. You can select a plan that seems appealing based on price, and later learn your dentist isn’t part of the network.
Avoid surprises. Shop with these four tips in mind and pick the dental plan that’s just right for your needs.
Call 855-419-3035 to learn more about purchasing dental insurance.
1. Review your coverage options and compare them to your oral health needs in a typical year.
The dental insurance marketplace includes many plan designs with a range of premiums, some as low as $14.99 per month at HealthCare.com. As with health insurance, what works for one individual or family may not work for another. Low cost may mean low benefits—which is fine, unless you use a lot of dental services.
Consider your oral health needs in a typical year. Do you routinely seek preventive care and rarely need fillings or other dental work? Or do you have oral health concerns and tend to need dental work most years? If so, what sort?
In addition to monthly premium amounts, look at the coinsurance rates for preventive care (e.g., cleanings and exams), basic care (e.g., simple extractions and fillings), and major care (e.g., crowns, bridges and oral surgery); dental deductibles (i.e., the amount each insured person must pay for basic and major services before benefits apply); and the maximum benefit amount (i.e., what the plan will pay for services in a policy term).
2. Know the difference between dental discount plans and dental insurance plans.
When comparing options, be mindful of what type of dental products you are considering. Some may be dental insurance plans, while others may be dental discount plans. Both can be helpful when it comes to paying for dental care, but they are quite different.
Dental discount plans
Are low-cost memberships that provide you access to discounted services from participating providers. Discounts may range from 10 to 50 percent off dental care including cleanings, fillings, X-rays and other services.
With a dental discount plan, there is no claims process. It is like belonging to a warehouse store or using a coupon. You present your membership card at your appointment and discounts are applied to your services. You then pay the amount due out of pocket. Many times these membership plans include other discount benefits as well on services such as vision, chiropractic and prescription drugs.
Dental insurance plans
Provide cost-sharing for oral health services. You apply, enroll and pay a monthly premium as you do with health insurance. Benefits vary by service. Preventive care, which typically includes two routine exams and professional cleanings annually, is often covered at 100 percent and is not subject to a copay or deductible. Dental services that fall into diagnostic, basic and major care may be subject to a deductible, coinsurance and a copay, depending on the plan.
As for charges for care received, the provider will file a claim with your insurance company, which will then pay the provider and bill you the amount for which you are responsible. You may be subject to an annual maximum benefit, which means once you exceed the amount your dental insurance company will pay in the policy year, you must pay for additional care out of pocket.
3. Find out if the plan has a dental network. If it does, determine whether or not your dentist is an in-network provider.
Different dental insurance plans have different network designs. The most common are as follows:
- Health maintenance organization (HMO) dental plans require you to use a network provider for dental care. HMOs typically have the lowest monthly premiums and out-of-pocket costs. However, if you seek care out of network, your dental benefits are unlikely to apply and you should expect to pay for services in full.
- Preferred provider organization (PPO) dental plans allow more flexibility when it comes to selecting providers. A PPO plan includes a dental provider network but also allows you seek care out of network; however, that out-of-network care will cost you more out of pocket. Monthly premiums for PPO plans tend to cost more than those of HMO plans.
- Indemnity dental plans (also known as fee-for-service plans) tend to offer the most provider flexibility. Network restrictions do not apply, so you can see any dentist you like—some plans may offer access to a network whose providers offer members discounted care. With a dental indemnity plan, you will be responsible for paying for care out of pocket and submitting a claim to the insurance company for reimbursement.
Be aware of these network structures. As you narrow your plan options, find out of your preferred dentist participates in the network. If you do not have a preferred dentist, check the plan’s provider directory to see what dentists participate and if they are conveniently located. Sometimes plan directories are out of date; you may call the insurance company’s member services to confirm your provider is in network and the provider to be sure your insurance is still accepted.
4. Understand the coverage details. Are there waiting periods before you can access care?
Waiting periods are a key thing to be aware of when selecting coverage. Most dental plans cover preventive care, including routine exams, professional cleanings and oftentimes X-rays, at 100 percent and with no waiting period. Basic and major services may be subject to waiting periods that range anywhere from six to 18 months. Be aware of these waiting periods when you shop, especially if you expect to seek dental care in the near future. This is a key reason you should buy dental insurance before you need it, so you can use it when you do—and better yet, take advantage of preventive services to help avoid more costly care.
See what dental insurance plans are available in your area; get a quick quote at HealthCare.com. If you need help deciding what coverage is right for you, call (877) 626-1943 to talk to a licensed insurance agent from one of our trusted partners.