Created by FindLaw's team of legal writers and editors | Last reviewed May 31, 2017
Your smile is an important part of who you are. For both health and cosmetic reasons, many of us seek regular dental care to keep our teeth healthy and strong. Legally, you aren’t required to maintain dental insurance. However, depending on your health and medical background, it may be a good idea for you to be covered. Read on to learn more about dental insurance.
Dental Insurance Basics
Dental insurance can help you pay for different types of dental care and procedures, which can otherwise be expensive when paid out-of-pocket. Typically, dental insurance policies will cover basic care, including two annual checkups and cleanings, x-rays, and fluoride treatments. The emphasis is placed on prevention and diagnostics to avoid major procedures down the line.
Many dental insurance policies are based on "100-80-50" coverage. This means that the policy will pay for 100% of routine preventative and diagnostic care, 80% of the cost for fillings, root canals and other basic procedures, and only 50% of the cost for crowns, bridges, and other major dental procedures.
The majority of dental insurance in the U.S is provided through employers. Some employers also offer dental insurance as a "rider" attached to a health insurance policies. Individual dental insurance policies can also be purchased. However, individual plans often include the drawback of waiting periods. Typically, an individual dental insurance policy won't cover fillings for the first 6 months of a policy, and may not offer coverage for other procedures for up to 18 months. So, it's typically not a good idea to wait until you have an issue with your teeth before shopping 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.
Generally, Health Maintenance Organizations (HMOs) plans only cover treatment with dental professionals within a limited network. 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.
Preferred Provider Organizations (PPOs) are a popular choice for dental insurance. PPOs allow patients to visit dentists outside the "preferred" network, however, patients are charged a reduced rate if they choose to see an in-network provider. An advantage to PPOs is that providers within the network will agree to accept lower fees for procedures, resulting in a negotiated discount, and the dentist won't bill you for the difference.
Indemnity plans allow you to see any dentist that you’d like. Typically, your dental insurance plan will 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, and then submit a claim to your insurance carried in order to be reimbursed.
Discount Dental Plans
Discount dental plans are like a membership program. You pay an annual fee to join, and then you get access to discounted dental services through participating dentists. The amount of the discount typically ranges from 10 to 60 percent for normal dental work.
Is Dental Insurance Worth the Cost?
Some people decide to pay out of pocket for dental care rather than paying dental insurance premiums. Whether this course of action makes sense for you will depend on your specific circumstances. You may want to examine the historical annual costs of your dental procedures, and then compare this total to the expense of insurance premiums. A benefit of health insurance you should include in your analysis is that insurance expenses can be deducted on your taxes.
When making the decision of whether to pay for dental insurance, it's important to also consider your overall health and any history of dental problems that you've had. Even if you’ve generally been blessed with a healthy mouth, dental insurance can be a major benefit for bigger-ticket procedures that may become necessary unexpectedly, like fillings, root canals, and crowns. Many feel that paying the premiums for dental insurance is simply worth it for having the peace of mind.
Procedures that Dental Insurance Does Not Cover
There’s some dental work that insurance generally doesn’t cover and that must be paid out-of-pocket. This includes:
- Cosmetic procedures
- Tooth whitening
- Orthodontic treatments like braces
- Dental implants
- Dental care related to medical conditions
All dental insurance policies differ, so if you're not sure if a certain procedure is covered by your insurance, it's best to check coverage limits and speak with your insurance company to be certain exactly what is covered.
Get Legal Advice About Dental Insurance
If you have legal questions about dental insurance or a claim with your dental insurance provider, it may be useful to seek legal advice. The FindLaw Lawyer Directory can help you find experienced attorneys in your area practicing insurance law.
You Don’t Have To Solve This on Your Own – Get a Lawyer’s Help
Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.