Dental insurance can be worth the investment if you shop around for coverage. Premium rates, deductibles, and copays all factor into the cost of a plan.
Like a health insurance plan, most dental insurance plans have a cap on how much they will pay during a plan year, called an annual maximum. You will pay for any expenses that exceed this limit.
Preventive Care
Many dental insurance plans cover preventive care, including regular checkups, cleanings, and X-rays, at little or no cost. Some also pay a portion of essential restorative services, like fillings or extractions. However, significant work such as crowns or implants can cost thousands of dollars, and those procedures typically have a high out-of-pocket expense.
Some plans have annual maximums that limit the amount the insurer will pay for costs in a year. You will be responsible for all additional expenses if you reach that maximum. In addition, be sure to look for a provider network size that includes dentists you know and trust.
Individual dental plans can be purchased standalone or as an add-on to a health plan in the Marketplace. To learn more, click the button below and answer a few questions about your income and household. You’ll then be able to preview health plans that include dental coverage and separate standalone dental plans.
Dental plans can come in many forms, including HMOs and PPOs. DHMOs generally have smaller provider networks and require members to visit in-network providers, while PPOs are more flexible and allow you to see out-of-network dentists. Also, there are discount dental plans, which don’t provide insurance but offer discounts to participating dentists.
Individual Plans
If you’re shopping for individual dental insurance, start by determining whether you want a preferred provider organization (PPO) or dental health maintenance organization (DHMO). PPO plans are similar to health insurance HMOs in that they only cover dentists in the plan’s network. This can save you money because the insurer negotiates discounted rates with the network dentists.
DHMOs are different because they let you choose any dentist, but the plan may have lower reimbursement rates and a smaller benefit limit. Choosing a DHMO can mean paying more out-of-pocket costs for procedures like fillings and root canals.
Major Procedures
Aside from preventive care, dental insurance helps cover significant procedures that can cost money. For instance, replacing missing teeth with implants or bridges can cost a thousand dollars or more. Dental insurance can help offset these expenses, but not all policies are created equal.
For example, some dental insurance plans require a higher premium but have lower copayments and deductibles. This is because these plans offer a high level of coverage, limiting the amount of money you pay for services once you’ve met the policy’s deductible and coinsurance requirements.
In addition, most dental insurance plans include an annual maximum, which caps the amount of money a plan will pay for services each year. This cap may apply to individual or family plans. It may also be tied to specific services like orthodontia.
The annual maximum is usually based on a typical or usual fee the American Dental Association sets. However, many DHMO and dental indemnity products allow you to roll some portion of unused annual maximum over to the following year.
Most dental insurance plans exclude coverage for some or all pre-existing conditions. However, some providers will lift these clauses after a certain period. For this reason, it’s essential to understand how much coverage you’ll get from a particular plan before purchasing it.
Out-of-Pocket Costs
Depending on your plan type, premium rates, deductibles, and copayments vary significantly. These factors can all add up to a substantial cost, especially for significant procedures like dental bridges or root canals.
In addition to comparing premiums and annual limits, make sure you know whether the plan has a provider network or if it’s an indemnity plan that allows you to see any dentist. Generally, plans with more extensive networks offer lower out-of-pocket costs.
Insurance companies also typically set maximum coverage limits for the year. After a plan reaches this limit, any additional expenses will be your responsibility. These caps are often lower for preventive services and higher for basic and major procedures.
Most insurers have a list of dentists in their network online, so you can check before signing up to determine if your preferred dental care providers are on the list. You can also use this tool to compare plans to find the best value for your budget.
The best plans offer 100% coverage for preventive services, 80% for basic procedures, and 50% for significant work. Indemnity plans usually have a broader range of out-of-pocket costs, but they can be more expensive in the long run.
