A beautiful smile is priceless. But there is definitely a cost associated with maintaining good dental health.
Statistics, however, suggest dental health may not be a large concern for many adults. The American Dental Association posted the results of a Health Policy Institute Research Brief
conducted in 2014; it found that 21.3% of adults had not visited the
dentist in more than three consecutive years. According to this same
study, only 11% completed a routine dental visit every two to three
Let’s rewind. Approximately 21% of the participants admitted
to having a gap of multiple years in between their last dental cleaning
and the survey. Further analysis has revealed some root causes
associated with this data. While reasons such as inconvenience and good
dental hygiene surfaced, the most common response for why people who
refused to undergo bi-annual cleanings and exams—money.
According to a national study, “Why Adults Forgo Dental Care: Evidence from a New National Survey,” nearly half of the participants indicated their dental care is not a priority because of the associated cost.
Money does not have to be your excuse though, especially
when dental coverage is widely available. In most cases, people are
eligible to receive dental insurance through their employer or their
spouse’s health insurance company. Yet earning a low income or being
unemployed is not an indication your dental care has to suffer. There
are various options for effective dental insurance and alternative
coverage accessible to everyone regardless of employment status.
If you want to learn more about dental insurance, keep
reading. This blog will explain your dental coverage options. It will
also teach you how to shop for the best and most affordable dental
insurance plans to address all of your dental needs and those of your
First, let’s start by discussing your options. Choosing a
dental plan can be confusing. Most insurance companies offer the same
basic plans; however, the features may vary. Let’s simplify your options
by identifying the type of dental insurance plans available as well as a
variety of dental coverage options to help pay for preventative care or
What are your options for dental insurance?
When it comes to dental insurance, there are a few basic types available. HMO, PPO, dental indemnity and dental discount plans. Regardless of which insurance plan you choose, most plans require a co-payment or co-insurance fee before dental services can be rendered. Let’s look these four types of coverage to understand the pros and cons as an insured.
A Dental Health Maintenance Organization, this type of
health insurance plan places certain limitations on available dentists
and services. It also may be considered the most affordable dental plan.
On the other hand, a DHMO does not allow as much freedom as a DPPO, for
- Under a DHMO, an insured will have the lowest possible monthly premiums.
- While DHMOs do require a specific deductible, these plans rarely have a maximum annual amount for coverage.
- Insureds have access to unlimited dental care services within a year.
- Under a DHMO, insured parties are restricted to a specific list of dentists. Most of whom handle both general and specialized dental care.
- Not every DHMO will allow insureds to “opt out” of a network dentist list i.e. if your preferred dentist is not considered to be in “network”, then you could pay an astronomical amount to receive services at their office.
- The decision to use an “out of network” provider will result in a higher out-of-pocket expenses for the insured.
A Dental Preferred Provider Organization, this type of
health insurance plan provides much more flexibility with dentist
selection than a DHMO offers, but the luxury of freedom comes with a
- A DPPO will pay for most of the services provided by dentists within a specified “network” list.
- Insureds truly have the option to choose between a “network” or “out of network” provider.
- While annual maximum limits do exist, if the insured needs dental services that exceed the annual maximum amount, a deep discount will be offered on all additional services.
- Under a DPPO, the insured will pay a higher monthly premium.
- The percentage paid by the DPPO plan may vary, depending on the services provided. Ex. DPPO will usually pay 80% of a bill for preventative care. Under this same plan, the insurer may only pay 50% toward major services such as installing a dental crown or getting dentures.
- If the insured chooses an “out of network” provider, he or she should be prepared to pay a higher percentage for any professionally recommended service.
- The insured must pay a specified deductible before a DPPO will pay its portion of the costs for a certain type of service.
- If the insured receives dental services that exceed the annual maximum limit, the insured will be responsible for paying for the remaining balance and the full cost of any additional services.
Dental Indemnity Plans
are also known as “traditional dental plans” or “fee for
service dental plans.” Indemnity plans rank in between DHMO and DPPO
plans by offering a mix of the best of both types of plans.
- Under an Indemnity Plan, the insured will enjoy absolute freedom to choose whichever dentist he or she prefers to provide their dental services.
- This plan’s co-pay and deductible structure is similar to that of a DPPO.
- In this plan, the insurance company usually follows the 80-20 rule. The insurance company will accept 80% responsibility for an insured’s service charges; the insured is responsible for the remaining 20%.
- Indemnity plans usually have the highest monthly premiums of any dental insurance plan.
- Dental services are often paid up front by the insured. A claim is submitted and then the insurance company takes action to reimburse the insured.
- It is common for an Indemnity Plan to offer a waiting period of at least 12 months for major services.
Discount Dental Plans
Private dental offices can choose to offer discount plans
to patients who do not have coverage under a dental insurance policy. A
discount plan does not qualify as dental insurance; instead, it simply
allows enrollees to receive full priced dental services at a discount.
Payment arrangements are also scheduled with the insured to help break
down the total amount into smaller monthly payments.
- Discount Dental Plans= instant discounts!
- Generally, these discount plans offer low, affordable monthly fees.
- The insured is not limited to which services will be approved due to an annual maximum amount.
- There is NO waiting period before an insured can schedule a procedure.
- The insured will be required to pay more out-of-pocket expenses through a dental indemnity plan than any other dental plan.
- Enrollment is required. Without enrolling in a Discount Dental Plan, the “deep discounts” are unavailable.
- When choosing the “right” type of dental coverage, what do you need to consider?
- The “right” type of dental coverage can vary depending on the needs of individual and his or her household. While there are at least a dozen conditions to consider, let’s take a closer look at five major components. Before deciding on an insurance plan to meet your dental needs and those of your family, learn how to measure each plan’s DCAPP—Deductible, Coverage, Annual limits, Premium and Percentage.
- It may be easiest to create a spreadsheet or draw out a simple comparison chart to most effectively analyze the plan features offered. Grab your smart phone, laptop or a blank piece of paper, and get to work.
This is a common term, but how many people fully understand when and how it comes into effect? A deductible is defined as a certain amount of money specified by the insurance company that must be paid by you, the insured, prior to your dental coverage being considered active.
Be mindful of how much of a deductible the insurance company is requiring. After all, this is the amount you must pay out-of-pocket BEFORE your selected insurance company will make a monetary contribution toward their agreed percentage of coverage for your dental care. Deductible specifications vary based on the plan and/or the company. Some dental insurance companies may require the insured pay a deductible before they receive any preventative or diagnostic treatment. Others may not require a deductible before you receive a routine cleaning and x-rays.
Consider your dental needs. If you regularly visit the dentist or have a history of good dental health, it may be best to stick with dental coverage that does not require a deductible for preventative care. On the other hand, if your last dental visit was three years ago, it might be best to consider how a deductible may affect you.
Analyze whether a high or low deductible is in your best interest. Looking at this factor alone is problematic. It doesn’t take a rocket scientist to recognize a low deductible is less painful to your wallet. Instead you should actually consider the offset of the deductible with other plan features including the annual maximum limit required, the percentage of serious procedures and the actual treatment covered.
When choosing a dental insurance plan or dental coverage, it is wise to actually review the type of treatment covered and any associated stipulations or exclusions. Under an insurance company’s umbrella of coverage, you’ll quickly learn every plan offers a variety of different benefits. This could also mean that some plans may fail to be inclusive of all your dental needs, whether in terms of the number of visits allowed and the amount of procedures.
Start with the doctor. Check to see if your preferred dentist participates as a “network” provider with the insurance company you are currently considering. This is very significant and could mean the difference in paying a co-payment, co-insurance or a much larger out-of-pocket expense. You may also become responsible for submitting a benefits claim to the health insurance company; in some cases the dentist office will submit the claim on your behalf. The easiest way to obtain key information is to contact the dental office to inquire about their participatory status. Ask some of the following questions: Which insurance companies consider the dentist as a “network” participant? Does the dentist anticipate a status change in the coming year or so? What type of insurance plans does the dentist accept- HMO, PPO, or Indemnity? Do they offer a discount plan?
If you do not have a preferred dentist, then stick with a dental provider listed on the recommended list of “network” providers. This guarantees you receive the most affordable insurance options available.
Next, consider the cost of the procedures covered under your benefits. The National Association of Dental Plans highlights the following seven areas of dental care.
- Preventative care- cleaning, routine cleaning
- Restorative care- fillings and crowns
- care- root canals
- Oral surgery- tooth removal and minor surgical procedures such as tissue biopsy and drainage of minor oral infections
- Orthodontics- retainers, braces, etc.
- Periodontics- scaling, root planning and management of acute infections or lesions
- Prosthodontics- dentures and bridges
Finally, read the fine print! While this is a common bit of advice, how often do you neglect to heed it? Pay attention to special clauses. Also look for specific language about dependents.
Watch out for “benefit period”. This term is usually a red flag. So stop and read carefully to gain thorough comprehension of the clause. The term “benefit period” is synonymous with your agreement to voluntarily opt into a long waiting list for certain procedures. Typically, you could be forced to wait anywhere from six months to a year before being allowed to schedule a major procedure AND be eligible to receive coverage under your dental benefits.
Real Life Scenario: Bob does not have a dental insurance policy, but he is shopping around for the best dental benefits. Bob also read this blog and knows he needs to consider deductible payments and the annual maximum limit to select the best insurance plan to meet his needs. Additionally, Bob has full knowledge that he will need a root canal in the near future. In fact, during his last routine cleaning, the dentist informed him that he would need to start considering a root canal. That was three years ago!
Bob is researching ABC Insurance, but he needs to pay particular attention to the fine print hidden within the “benefit period” clause. If he completes the procedure before the insurance company approves coverage, Bob could end up paying out more money than he ever imagined! Why? There is a large possibility that upon enrollment, Bob unknowingly agreed to wait a full twelve months before ABC Insurance would consider his root canal as covered. The policy clearly states that ABC Insurance will not cover his procedure until a year from enrollment. Note: “a year” may or may not translate into a full twelve months depending on the type of dental benefits you select.
Annual Maximum Limit
By definition, the annual maximum limit is the cap at which an insurance company sets an insured’s dental care within a specified benefit period. The aforementioned benefit period is usually marked by a calendar year (January through December). Paying close attention to this number is important. When a procedure exceeds the annual maximum limit, you as the insured will be responsible for paying the difference beyond what the insurance company is contracted to pay.
The National Association of Dental Plans reports about 50% of Dental PPO plans have a maximum annual dental limit of $1,500.00. The associated deductibles are typically $50.00 or $100.00. Remember if you may need multiple dental procedures or a more expensive procedure in the future, it may be best to consider getting a Dental HMO plan. These plans rarely ever enforce a maximum annual limit.
The premium is the amount of money you will pay each month for your dental benefits. If you have dental insurance through your employer, it’s easier to ignore the money that’s being sucked out of your check for dental care. However, if you have decided to invest independently, it is easy to become extremely protective of your monthly earnings.
Weigh your options between a smaller premium and a potentially higher deductible. Tally your regular expenses; based on the results, decide how much you’ll have to pay out each month for dental insurance. As with any insurance plan, failure to pay your monthly premium means your coverage will be canceled. Ideally, you’ll want to focus on shopping for a dental plan that fits comfortably within your financial budget and goals.
Another viable question: how much percentage will the insurance company pay for the more serious procedures? Review the limitations and exclusions! When it comes to certain procedures, some insurance companies could aim to leave you paying the bulk of your dental care bill. Use your knowledge to find the best possible resolution for your dental care needs.
This article, by no means, is all-inclusive of every, solitary consideration necessary before selecting the best dental insurance plan. However, the goal is to provide an educational guide with a checklist to help you make the wisest decision possible regarding dental health for yourself and your entire family.