There’s more to dental insurance than a great smile. As it turns out, Guardian’s 2017 “Dental Benefits: A Bridge to Oral Health and Wellness” study shows the health of your teeth has a direct link to the health of your body overall. The best way to ensure teeth stay healthy is to regularly visit the dentist. The key to making those visits easy and affordable is dental insurance. Here’s what you need to know about getting dental insurance that works for you and your family.
It’s possible that everyone in your family will need preventive care. But dental needs may differ from person to person. For example, kids may require services such as fluoride treatments or sealants. Active kids may need help protecting their teeth from injury if they play sports. Adults may need services that help them prevent gum disease, or replace teeth that are lost due to aging or disease. Whatever dental coverage you choose, make sure it will accommodate as many of your family’s needs as possible.
While medical insurance may cover certain pre-existing conditions, dental insurance doesn’t always work this way. Many dental plans are designed to help you prevent oral health conditions that can cost a lot of money to fix, such as tooth decay. While it’s still possible to get dental insurance if you have an oral condition that needs to be fixed, there are dental insurance companies that will place waiting periods on certain procedures. This means if you delay signing up for dental insurance until you have an emergency, such as a painful broken tooth, you may end up either having to wait until the procedure is partially or completely covered by your plan, or pay out of pocket to fix the problem immediately.
What your dental insurance will not cover is just as important as what it includes. It’s important to consider how much you can afford to pay for dental services out of pocket in a given year. Dental plans on the market may include any combination of the following out-of-pocket costs:
- Deductibles that must be met before your services are covered.
- Waiting periods before coverage for certain services kick in.
- A coinsurance percentage for which you may be responsible.
- Fee-for-service arrangements where you must pay for services up front and receive reimbursement for some of the cost later.
These costs can be important to consider in the event you need oral care, especially if it’s an emergency.
Dental Health Maintenance Organizations (DHMO)
A DHMO dental plan –– is an arrangement where dentists contracting with an insurer agree to accept an insurance fee schedule and give their patients a reduced cost for services as an in-network provider. Patients must choose a primary care dentist from the insurer’s network of dentists.
You must choose one-in network dentist from the DHMO network who will serve as your primary care dentist. If you don’t choose a dentist, a primary care dentist will be assigned to you in your area. All care must be provided and arranged by your primary care dentist. There’s no out-of-network coverage.
DHMO waiting periods
Many DHMO plans do not have waiting periods.
What DHMOs cost
Premiums will vary. Many DHMOs do not have deductibles and may not include a maximum dollar payout for each benefit year.
Dental Preferred Provider Organizations (DPPO)
A PPO dental plan provides their members access to a network of participating dentists who have agreed to accept discounted fee for services provided. Under a PPO dental plan, members can see a non-network dentist but at a higher out-of-pocket cost.
A PPO dental plan has a wide network of dentists you can visit. PPO plans are designed to incentivize choosing an in-network dentist by offering better benefits in-network at discounted fees.
PPO waiting periods
There are no waiting periods for preventive care such as cleanings, exams, and x-rays. Major dental work, such as crowns, dentures, implants, and Orthodontics (braces), may have varying waiting periods depending on your dental plan.
What PPOs cost
Premiums will vary. Some PPO plans do not require a deductible for preventive care if you use an in-network dentist.
A dental indemnity insurance plan is a “fee-for-service” type of plan. You can visit any dentist you want. There are no dental networks. Dental insurance plans cover the amounts charged by the dentist, up to usual and customary amounts.
Dental indemnity waiting periods
Just like PPO plans, there are no waiting periods for preventive care, and major dental work may have a waiting periods that vary by plan.
What dental indemnity plans cost
Premiums will vary. You may need to meet a deductible before receiving reimbursement for services. You may have to pay up front for the services you need, which means your costs will vary based on the dentist you see.
Group dental insurance can be provided by an employer. Based on the needs of the workforce and the affordability of the plans, your employer may work with a dental insurance company to design multiple plan options for you to choose from.
Group dental insurance networks
The network size doesn’t vary most of the time, but double-check based on the types of plans your employer offers.
Group dental insurance waiting periods
Waiting periods will typically follow that of PPO and DHMO plans, with no waiting period for preventive services and varying waiting periods for major dental work and braces.
What group dental insurance plans cost
Costs will vary based on the options your employer provides. Plans could include a deductible you must meet.
Your dental insurance should offer a strong network that gives you plenty of dental provider options in your area. Your may want your insurance company to make it a point to include providers that value preventive care and work to help you get the best care possible while helping save you money.