Health insurance covers you for healthcare services and medical procedures. Dental insurance covers you for oral health and dental problems. Some health insurance plans include basic dental coverage, and stand-alone dental plans are also available that offer basic dental benefits.
If you find that none of these options meets your needs, there’s one more alternative to consider: supplemental dental insurance. But what exactly is supplemental dental insurance? Is it worthwhile having, or will basic dental coverage do the job? Who needs supplemental dental coverage, anyway?
If supplementary dental coverage has you confused, don’t fret. We answer all of those questions and more in this comprehensive guide to supplemental dental insurance.
What Is Supplemental Dental Insurance?
Supplemental dental insurance is a separate dental plan you can purchase to fill in the gaps in your existing dental coverage. You can pair it with a Medicare Advantage plan, or any other dental plan, to give you more dental benefits.
However, even though used to supplement another dental plan, supplemental dental coverage carries its own premium. Therefore, it gives you more dental benefits, but at an added cost, because you will pay an additional premium every month.
You are not required by law to have any supplemental insurance. Your decision to get this type of insurance is yours, and yours alone. But once you know how primary and supplemental insurance work together, you may want it.
Does The Affordable Care Act Regulate Supplemental Dental Insurance?
You may choose to purchase dental insurance and supplementary dental insurance in the private dental insurance market or on the ACA insurance marketplace.
With either option, you can do so on your own, or through an insurance broker or advisor, like Enhance Health. Take note that, although ACA health plans include dental coverage for children, they are not required by law to do so for adults.
Therefore, you may find that while some plans offer dental coverage, some do not. Also, the coverage degree may differ between the different tiers of the ACA marketplace.
How Does Primary And Supplemental Dental Insurance Work Together?
Under the Affordable Care Act, dental health coverage is guaranteed for kids up to age 19 as an essential health benefit. However, the same right is not afforded to adults. Even when ACA- health plans offer dental coverage, they are often limited to very basic oral health and dentistry.
Luckily, additional dental insurance can cover any remaining costs and fill in any missing coverage. Primary and supplemental dental insurance work together to provide more comprehensive dental insurance coverage with more extensive benefits.
Get Around The Annual Maximum
Your primary dental insurance coverage will have an annual maximum. If you need additional dentistry that is not covered, or that takes you over the year’s maximum, you’ll pay out of pocket or have to wait until the next coverage period. Supplementary insurance can help you get around that.
Basic dental cover usually won’t cover advanced dentistry procedures such as bridges, dentures, and dental implants. Primary dental plans may not always cover root canals, even though many people consider them as basic dentistry. Of course, this depends on the specific dental plan you have.
You can use supplementary insurance to cover these extra procedures.
Lower Out-Of-Pocket Expenses
On any dental plan, just like any health plan, you’ll have a fair amount of out-of-pocket expenses, like deductibles and cost-sharing.
These are unavoidable, although the exact amounts will differ from one plan to the next. You can use some supplementary dental plans to lower these extra expenses, saving you money while you get the dental insurance coverage that you need.
Insurance companies do not design basic dental coverage to meet the needs of every individual for every dentistry need. Basic coverage aims to address the oral healthcare and dentistry needs of individuals with limited requirements.
However, we are not all the same. Just as with healthcare and medical procedures, we all have different needs.
That’s what makes supplementary dental insurance so popular. By supplementing your basic dental coverage with a plan that covers the specific dentistry procedures you need, you tailor your dental coverage to suit you.
More Cover For Specific Procedures
Sometimes the type of benefits your basic dental plan offers is not the problem, but the extent of the coverage. The dental treatments you need may indeed be covered, but not to the amount that you need. Supplementary dental coverage can give you more coverage for those urgent dental procedures.
Dental Insurance Waiting Periods
Dental insurance waiting periods can be a big problem if you urgently need dental work done. If you can’t wait, you’ll have to cover the costs of your dental procedure out-of-pocket. Purchasing a supplementary dental plan that does not have the same waiting period for that procedure may be the answer.
Types Of Supplemental Dental Plans
Similar to ACA health plans, there are different types of dental plans available. Additionally, there are various supplemental dental plans to choose from. Your choice will dictate how much you pay as well as how much freedom you have in choosing where to have your dental work done.
A dental indemnity plan will usually not restrict you in your choice of provider. You can choose any licensed dentist for your treatments. After you pay for your procedure, the plan will reimburse you for a portion of the costs. This could be anywhere from 50% to 80%.
Managed Care Plan
With a managed care plan, you must choose a primary care dentist. They will manage your care, and any necessary referrals, while on the plan. This type of plan is usually quite affordable, as you will benefit from negotiated low prices on a dental provider network.
This is like a Health Maintenance Organization (HMO) health plan.
What Does Supplemental Dental Insurance Cover?
Supplemental dental insurance plans differ slightly depending on the type of plan purchased, and who the insurer is. However, supplemental dental insurance typically covers:
- Dental exams
- Teeth cleanings
- Dental X-rays
- Anesthesia for dental procedures
It may also cover, at least partly, oral surgery, tooth extractions, and denture repair.
Who Can Benefit From Supplemental Dental Insurance?
So, who benefits from the addition of supplemental dental insurance?
Employees With Basic Dental Benefits
Many employees rely on health insurance offered by their employer. This may even include basic dental benefits. However, these basic dental benefits are seldom enough for their oral healthcare and dentistry needs.
People With Limited DentCoverage
Perhaps you are self-employed and have purchased an individual health plan from the ACA marketplace. Your health insurance plan might include limited dental coverage. However, it might not meet your dental needs.
College students might be young and healthy, but that doesn’t mean they don’t need insurance. Many college students struggle with oral health and dental issues. Supplemental dental insurance will address their requirements.
Older Adults On Medicare
As we age, dental problems arise more frequently, and the statistics are frightening. According to the Centers for Disease Control and Prevention (CDC) in the US, more than 13% of adults age 65 and older suffer complete tooth loss.
Taking care of your oral health early on can prevent a lot of this, but older adults with dental problems can still have hope.
Medicare is a federal health insurance plan, primarily for people aged 65 or older. Unfortunately, Original Medicare (Parts A and B) does not cover most dental services. Older adults on Original Medicare therefore qualify to use supplemental dental coverage.
Choosing The Right Supplemental Dental Insurance
Choosing the right dental insurance is like choosing any other type of insurance. You must be true to your situation, needs, and budget.
Assess Your Situation
If you are single, in good health, and take good care of your teeth, basic dental insurance will probably meet your limited requirements. But if you have a family depending on you for their dental care, or you are at risk for oral health issues, it’s different. You will more than likely need supplemental dental insurance.
Acknowledge Your Needs
Many dental problems, like gum disease, tooth loss, or brittle teeth, stem from poor lifestyle choices, an inadequate diet, or substance use. If you have serious oral health or dental issues or have a history of such issues, you should probably have supplemental dental insurance.
As the name suggests, supplemental dental insurance does not intend to supplement existing dental coverage. It can help you access dental services that you would not otherwise have on basic dental plans, or have extra coverage for more expensive dental procedures.
Whether you need supplemental dental insurance depends on your unique situation. Some people have higher needs for oral care and dentistry. That’s why you must get the right dental coverage from the start. Enhance Health can help.