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Dental Insurance

Your smile is an important part of who you are. For both health and cosmetic reasons, dental health is essential. Many seek regular dental care to keep their teeth healthy and strong. Often, it's a benefit provided by your employer, along with other types of insurance that include:

You aren't required to maintain insurance coverage for your dental care. However, it's a good idea to explore plan options. Even preventive services may be costly.

Coverage options, including exclusions and deductibles, vary widely depending on the benefit plan selected. Read on to learn more about dental benefits.

Dental Insurance Basics

Dental insurance can help you pay for dental care. Otherwise, the entire cost of your dental procedures, from preventive care to major services, would constitute an out-of-pocket cost.

Typically, dental insurance policies cover basic oral health care. Most dental health plans cover the following:

  • Two annual checkups
  • Two annual cleanings
  • X-rays
  • Fluoride treatments

Dental plans, including dental PPOs, emphasize prevention and diagnostics. This approach not only provides health benefits to insureds, it also benefits insurance companies. The emphasis is placed on prevention and diagnostics to avoid significant procedures down the line.

Many dental insurance policies base coverage on "100-80-50." This means that the policy will pay for the following:

  • 100% of routine preventative and diagnostic care
  • 80% of the cost of fillings
  • 80% of the cost of root canals
  • 80% of the cost of other basic procedures
  • 50% of the cost of crowns, bridges, and other major dental procedures as determined by the insurer

In the U.S., employers provide the majority of dental insurance. Some employers also offer dental insurance as a rider for health insurance policies.

Individual dental insurance policies can also be purchased. Individual plans often include the drawback of waiting periods. For example, an individual dental insurance policy often won't cover fillings for the first six months of a policy.

They may also not cover procedures for up to 18 months. It's not a good idea to wait until you have a dental issue to shop for dental insurance.

Types of Dental Insurance Plans

The most common types of dental insurance policies are HMOs, PPOs, and indemnity plans. Recently, dental discount plans have also increased in popularity.

HMOs

In general, Health Maintenance Organizations (HMOs) plans only cover treatment from in-network dentists. With HMOs, you pay a fixed copayment at the time of service. One advantage of HMOs is that they do not have any waiting periods for procedures.

PPOs

Preferred Provider Organizations (PPOs) are a popular choice for dental insurance. PPOs allow patients to visit in-network dentists and out-of-network dental providers.

Enrollment in a dental PPO affords more choice. Patients have the flexibility to choose an out-of-network provider. Other benefits of a dental PPO can include:

  • A more extensive network of dentists, which can consist of providers outside the PPO plans' dental network
  • There is no need to obtain a referral before visiting a specialist
  • You do not need to designate a primary care provider

Members often receive a lower out-of-pocket cost if they select an in-network provider. Providers within the network will typically agree to accept lower fees for procedures. You would receive the resulting negotiated discount. The dentist won't bill you for the difference.

Indemnity Plans

Indemnity plans allow you to see any dentist. Your dental insurance plan will usually pay a fixed percentage of the cost of your dental work. With this type of plan, you must pay for the cost of your treatment in full. Then, you submit a claim to your insurance carrier for reimbursement.

Discount Dental Plans

Discount dental plans are like a membership program. You pay an annual fee to join and get access to discounted dental services through participating dentists. The discount typically ranges from 10% to 60% for routine dental work.

Is Dental Insurance Worth the Cost?

Some people decide to pay out of pocket for dental care to avoid paying dental insurance premiums. Whether this makes sense for you depends on your circumstances.

When deciding whether to pay for dental insurance, it's essential to consider the following:

  • Your overall health
  • Your history of dental problems
  • Cost of premiums
  • The level of flexibility that suits your needs

Dental insurance can be a significant benefit even if you have good dental health. You'll appreciate the advantages of dental insurance for bigger-ticket procedures. For example, the following procedures can be unexpected and expensive:

  • Fillings
  • Root canals
  • Crowns

Many insureds believe paying dental insurance premiums is worth the peace of mind.

Procedures Dental Insurance Does Not Cover

Dental insurance only covers some types of procedures. You are required to pay the total cost for specific procedures. Such procedures may include:

  • Cosmetic procedures
  • Tooth whitening
  • Orthodontic treatments like braces, although some policies may cover a portion of the cost
  • Dentures
  • Dental implants
  • Dental care related to medical conditions

Each dental policy is different. If you are uncertain whether a particular procedure is covered, speak with your insurance company. They should be able to explain what is and isn't covered.

Get Legal Advice About Dental Insurance

If you have legal questions about dental insurance, dental coverage, or a claim, seek legal advice. This is especially true when you have attempted to get answers from your dental insurance provider but still need help.

The FindLaw.com Lawyer Directory can help you find experienced attorneys in your area practicing insurance law.

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Next Steps

Contact a qualified attorney to assist with any issues related to insurance.

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