{"id":352578,"date":"2017-05-31T18:02:46","date_gmt":"2017-05-31T23:02:46","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/consumer\/insurance\/dental-insurance.html"},"modified":"2024-03-12T14:20:40","modified_gmt":"2024-03-12T19:20:40","slug":"dental-insurance","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/consumer\/insurance\/dental-insurance.html","title":{"rendered":"Dental Insurance"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n    \n    <div class=\"fl-page-articles fl-section-main fl-section-main-full-width\">\n        <h1 class=\"fl-no-margin-top\">Dental Insurance<\/h1>\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/oni-harton-j-d\/\">Oni Harton, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/melissa-bender-esq\/\">Melissa Bender, Esq.<\/a>\n                | Last updated\n        <time>\n                            March 12, 2024\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n<p>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&#8217;s a&nbsp;<a href=\"https:\/\/www.findlaw.com\/employment\/wages-and-benefits\/health-insurance-and-benefits-your-rights.html\">benefit provided by your employer<\/a>, along with other types of insurance that include:<\/p>\r\n<ul>\r\n<li><a href=\"https:\/\/www.findlaw.com\/consumer\/insurance\/health-insurance.html\">Health insurance<\/a><\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/consumer\/insurance\/life-insurance.html\">Life insurance<\/a><\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/what-is-disability-insurance.html\">Disability insurance<\/a><\/li>\r\n<\/ul>\r\n<p>You aren&#8217;t required to maintain insurance coverage for your dental care. However, it&#8217;s a good idea to explore plan options. Even preventive services may be costly.<\/p>\r\n<p>Coverage options, including exclusions and deductibles, vary widely depending on the benefit plan selected. Read on to learn more about dental benefits.<\/p>\r\n<h2>Dental Insurance Basics<\/h2>\r\n<p>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.<\/p>\r\n<p>Typically, dental insurance policies cover basic oral health care. Most dental health plans cover the following:<\/p>\r\n<ul>\r\n<li>Two annual checkups<\/li>\r\n<li>Two annual cleanings<\/li>\r\n<li>X-rays<\/li>\r\n<li>Fluoride treatments<\/li>\r\n<\/ul>\r\n<p>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.<\/p>\r\n<p>Many dental insurance policies base coverage on&nbsp;&quot;100-80-50.&quot; This means that the policy will pay for the following:<\/p>\r\n<ul>\r\n<li>100% of routine preventative and diagnostic care<\/li>\r\n<li>80% of the cost of fillings<\/li>\r\n<li>80% of the cost of root canals<\/li>\r\n<li>80% of the cost of other basic procedures<\/li>\r\n<li>50% of the cost of crowns, bridges, and other major dental procedures as determined by the insurer<\/li>\r\n<\/ul>\r\n<p>In the U.S.,&nbsp;<a href=\"https:\/\/www.findlaw.com\/smallbusiness\/employment-law-and-human-resources\/health-insurance-overview.html\">employers provide the majority of dental insurance<\/a>. Some&nbsp;<a href=\"https:\/\/www.findlaw.com\/employment\/wages-and-benefits\/employee-benefits-questions-to-ask.html\">employers also offer dental insurance<\/a>&nbsp;as a&nbsp;rider&nbsp;for health insurance policies.<\/p>\r\n<p>Individual dental insurance policies&nbsp;<a href=\"https:\/\/www.healthcare.gov\/coverage\/dental-coverage\/\" target=\"_blank\" rel=\"noopener\">can also be purchased<\/a>. Individual plans often include the drawback of waiting periods. For example, an individual dental insurance policy often&nbsp;won&#8217;t&nbsp;cover fillings for the first six months of a policy.<\/p>\r\n<p>They may also not cover procedures for up to 18 months. It&#8217;s&nbsp;not a good idea to wait until you have a dental issue to shop for dental insurance.<\/p>\r\n<h2>Types of Dental Insurance Plans<\/h2>\r\n<p>The most common types of dental insurance policies are HMOs, PPOs, and indemnity plans. Recently, dental discount plans have also increased in popularity.<\/p>\r\n<h3>HMOs<\/h3>\r\n<p>In general,&nbsp;<a href=\"https:\/\/www.healthcare.gov\/glossary\/health-maintenance-organization-HMO\/\" target=\"_blank\" rel=\"noopener\">Health Maintenance Organizations<\/a>&nbsp;(HMOs) plans only cover treatment from&nbsp;in-network dentists.&nbsp;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.<\/p>\r\n<h3>PPOs<\/h3>\r\n<p>Preferred Provider Organizations (PPOs) are a popular choice for dental insurance. PPOs allow patients to visit&nbsp;in-network dentists&nbsp;and&nbsp;out-of-network&nbsp;dental providers.<\/p>\r\n<p>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:<\/p>\r\n<ul>\r\n<li>A more extensive network of dentists, which&nbsp;can consist of providers outside the PPO plans&#8217; dental network<\/li>\r\n<li>There is no need to obtain a referral before visiting a specialist<\/li>\r\n<li>You do not need to designate a primary care provider<\/li>\r\n<\/ul>\r\n<p>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&#8217;t bill you for the difference.<\/p>\r\n<h3>Indemnity Plans<\/h3>\r\n<p>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.<\/p>\r\n<h3>Discount Dental Plans<\/h3>\r\n<p>Discount dental plans are like a membership program. You pay an annual fee to join and&nbsp;get access to discounted dental services through participating dentists. The discount typically ranges from 10% to 60%&nbsp;for routine dental work.<\/p>\r\n<h2>Is Dental Insurance Worth the Cost?<\/h2>\r\n<p>Some people decide to pay out of pocket for dental care&nbsp;to avoid paying dental insurance premiums. Whether this makes sense for you depends on your circumstances.<\/p>\r\n<p>When deciding whether to pay for dental insurance, it&#8217;s essential to consider the following:<\/p>\r\n<ul>\r\n<li>Your overall health<\/li>\r\n<li>Your history of dental problems<\/li>\r\n<li>Cost of premiums<\/li>\r\n<li>The level of flexibility that suits your needs<\/li>\r\n<\/ul>\r\n<p>Dental insurance can be a significant benefit even if you have good dental health. You&#8217;ll appreciate the advantages of dental insurance for bigger-ticket procedures. For example, the following procedures can be unexpected and expensive:<\/p>\r\n<ul>\r\n<li>Fillings<\/li>\r\n<li>Root canals<\/li>\r\n<li>Crowns<\/li>\r\n<\/ul>\r\n<p>Many insureds believe paying dental insurance premiums is worth the peace of mind.<\/p>\r\n<h2>Procedures Dental Insurance Does Not Cover<\/h2>\r\n<p>Dental insurance only covers some types of procedures. You are required to pay the total cost for specific procedures. Such procedures may include:<\/p>\r\n<ul>\r\n<li>Cosmetic procedures<\/li>\r\n<li>Tooth whitening<\/li>\r\n<li>Orthodontic treatments like braces, although&nbsp;some policies may cover a portion of the cost<\/li>\r\n<li>Dentures<\/li>\r\n<li>Dental implants<\/li>\r\n<li>Dental care related to medical conditions<\/li>\r\n<\/ul>\r\n<p>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&nbsp;what is and isn&#8217;t covered.<\/p>\r\n<h2>Get Legal Advice About Dental Insurance<\/h2>\r\n<p>If you have legal questions about dental insurance, dental coverage,&nbsp;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.<\/p>\r\n<p>The FindLaw.com Lawyer Directory can help you find&nbsp;<a href=\"https:\/\/lawyers.findlaw.com\/insurance-law\/-law?fli=dcta\" target=\"_blank\" rel=\"noopener\">experienced attorneys<\/a>&nbsp;in your area practicing insurance law.<\/p>\r\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-up\" clip-path=\"url(#clip0_604_3418)\">\n                        <path id=\"Vector\"\n                              d=\"M6 21H3C2.46957 21 1.96086 20.7893 1.58579 20.4142C1.21071 20.0391 1 19.5304 1 19V12C1 11.4696 1.21071 10.9609 1.58579 10.5858C1.96086 10.2107 2.46957 10 3 10H6M13 8V4C13 3.20435 12.6839 2.44129 12.1213 1.87868C11.5587 1.31607 10.7956 1 10 1L6 10V21H17.28C17.7623 21.0055 18.2304 20.8364 18.5979 20.524C18.9654 20.2116 19.2077 19.7769 19.28 19.3L20.66 10.3C20.7035 10.0134 20.6842 9.72068 20.6033 9.44225C20.5225 9.16382 20.3821 8.90629 20.1919 8.68751C20.0016 8.46873 19.7661 8.29393 19.5016 8.17522C19.2371 8.0565 18.9499 7.99672 18.66 8H13Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\"\n                              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20.2154 1.55681C20.645 1.9255 20.9242 2.43905 21 3V10C20.9242 10.5609 20.645 11.0745 20.2154 11.4432C19.7859 11.8119 19.236 12.01 18.67 12H16M9.00003 14V18C9.00003 18.7956 9.3161 19.5587 9.87871 20.1213C10.4413 20.6839 11.2044 21 12 21L16 12V0.999995H4.72003C4.2377 0.994543 3.76965 1.16359 3.40212 1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        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<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Dental insurance can help greatly reduce costs associated with your teeth, but it&#8217;s important to understand how the system works. 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