Many significant advances have been made in oral care in the past decades. And yet, reports indicate that many Americans still suffer from dental and oral health problems. Fortunately, dental insurance exists to lessen the burden of the high costs of good dental care.
Dental plans work the same way as medical insurance and are usually quite affordable. But is it worth buying dental insurance? What will it cost, and are there any viable alternatives? We answer all these questions and more in this in-depth guide to dental insurance.
Understanding Dental Insurance
Dental insurance is similar to other types of insurance but designed for dental procedures, dentist room visits, and oral health. It can help you manage the costs of these services, especially when unexpected and unplanned dental emergencies arise.
But like any other type of insurance, dental insurance has both benefits and drawbacks. But these are not all determining factors for all people. Your unique circumstances will dictate how each of these relates to your situation.
The Pros And Cons Of Dental Insurance
Here are some generally accepted pros and cons of dental insurance that you should be aware of.
- Some dental plans include preventive dental services at 100% coverage, even before meeting a deductible. This does not apply to all plans, so please check the details for signing up for any plan.
- Access to good preventive care will encourage and motivate you to practice good oral care. It will keep your teeth healthy and strong and help you avoid serious dental issues like gum disease, tooth decay, and tooth loss.
- Dental insurance is generally affordable, and you should easily be able to find a plan with premiums that fit your financial situation. Many employers also offer some form of dental coverage. Remember to check with any new employer if this is the case.
- As with all insurance, you must pay your monthly premium even if you do not use the benefits.
However a monthly premium is worth all the benefits and is especially helpful should a dental emergency occur or should you need a costly procedure.Dental insurance helps you to plan for and pay for these services.
- Even with out-of-pocket payments, you usually pay less than without dental insurance. That is especially true if your dental plan uses a preferred or exclusive network of dental care providers.
- Dental insurance plans are not created equal. They may offer different benefits and coverage, subject to coverage exclusions and unique stipulations. Many dental insurance policies don’t cover cosmetic dentistry, dental implants, and other orthodontic services.
- Preferred or exclusive networks may apply. These plans are generally more affordable but also more restrictive. They limit your freedom to choose your provider. If you have a dentist you trust for your dental health who is outside the plan’s network, this could be an issue for you.
The Various Costs Of Dental Insurance
One of the top advantages of a dental insurance plan is that it is very affordable. You can get good dental insurance for just under $50 a month. However, your monthly premiums, the exact benefits, terms, and conditions will be determined by various factors.
For example, your location will dictate what dental plans are available in your state. The insurer you choose will determine whether or not you can have a standalone plan. Your dental plan might be a complementary part of more comprehensive health insurance.
And, of course, the number of dependents you wish to have covered under your dental plan will also affect the price.
Costs Covered By The Insurer
There are always conditions and limitations on the costs covered by the insurer.
Many dental plans cover preventive dental treatments and oral health services right away. But for more specialized dental procedures, a deductible will apply. There are also limits to what the insurer will pay for your dental services in any given year. This yearly coverage limit is known as the annual coverage maximum.
How Deductibles Work
As with medical and other forms of insurance, there is a deductible on most dental plans. That is the fixed dollar amount you must pay for covered services each year before the insurer pays anything. The exact figure may vary from one plan to the next.
How Annual Maximums Work
The annual coverage maximum may vary between dental plans, but they all have one. After you meet your deductible, the insurer deducts the amount they paid from the total annual maximum every time you receive dental services.
Once you reach the maximum, you’re fully responsible for your dental expenses, just like before you met the deductible. Both your deductible and your annual coverage maximum reset at the start of the following coverage year.
Can Benefits Be ‘Carried Over’?
Although some plans may offer the option of carrying over unused benefits to the following year’s annual maximum, this is not true of all plans. Terms and conditions may apply. Always check the fine print regarding this when signing up for a dental plan.
Expenses You Are Liable For
Dental plans operate similarly to medical insurance plans. You’ll have an obligation to pay a monthly sum called a premium. You must pay it whether or not you plan to use the dental insurance coverage that month.
The premium is the monthly amount you pay for the duration of your dental insurance plan’s coverage year. The amount will remain constant throughout the year but may increase at the start of the following coverage year.
If the dental plan is not a standalone one but part of a comprehensive health plan, the dental premium is included in the health plan’s monthly premium. Regardless of whether your dental plan is standalone, the obligation to pay the monthly premium applies even if you don’t use the dental benefits.
But when you do use dental services, you will have certain additional out-of-pocket payments aside from your monthly premium.
Depending on the particulars of your dental plan, you’ll face coinsurance or copay costs for dental services post-deductible. These out-of-pocket costs operate much like they do in medical insurance plans. It is especially applicable to services like orthodontics or dental surgery.
So, although your dental care is now ‘covered,’ you still pay something towards dental procedures.
Copayments are the fixed dollar amount you pay toward your covered dental services after meeting your deductible. Your dental plan may cover the dental procedure or dentist visit, but you may also have to pay a certain amount for each service.
Coinsurance is the portion of your dental expenses you are liable for after you meet your deductible for the year. It is what you will pay for dental services alongside what your insurance coverage pays. Unlike the copay, it is not a fixed dollar amount but is a percentage.
Covered Dental Procedures
If you’re interested in investing in your oral health, you’ll be pleased to know that different types of dental coverage are available.
Most dental insurance plans commonly focus on three dental or oral care categories. These are preventive, basic, and also major restorative care. A dental plan may cover all three or specialize in one or two. Although you may enjoy all three types of coverage, they have very different degrees of coverage.
- Preventive dental services include dental check-ups, teeth cleanings, and dental x-rays. These services are typically fully covered from the start.
- Basic dental services include fillings and extractions. Root canals may also be in this category. However, they may be subject to unique coinsurance or copay specifications. It depends on your specific dental plan. This type of dental care is typically subject to roughly 80% coverage.
- Major restorative dental work includes crowns, bridges, dentures, and similar services. The coverage for restorative care can be anywhere from 50 to 80%. As always, this largely depends on the exact specifics of your policy.
What Is Not Covered By Dental Insurance?
Dental plans can differ in what they do or don’t cover. However, many dental plans don’t cover cosmetic procedures like teeth whitening and veneers. Orthodontic services like braces also often pose a problem. However, when covered, this will usually be subject to a clause stating that it is a lifetime maximum benefit.
A lifetime maximum benefit contrasts starkly with other benefits that restart with each new coverage year. And there is another factor to consider. Even on dental plans that offer such services, your copay or coinsurance may be higher for such treatments.
Is It Worth Buying Dental Insurance?
Under the Affordable Care Act (ACA), all ACA-compliant health plans include certain essential services. They also offer basic dental coverage for children. But while this is good news for parents, it does not help them with their dental needs.
When you look for dental insurance coverage, you have two choices. Find a health plan that includes it for adults or purchase a standalone dental plan.
Dental insurance is worth buying, and here’s why. Any insurance, including dental insurance, is all about being prepared for the unexpected.
Dental procedures and even general checkups are expensive. Insurance helps cover these costs for an affordable monthly premium. As such, dental insurance is a good idea for most people, but particularly those with ongoing dental issues.
Are There Alternatives To Dental Insurance?
There are alternatives to traditional dental insurance, too. An example of this is a dental discount plan. They may sound as if they offer you the same advantages, but they are very different approaches to dental care that offer very different benefits.
Dental Insurance Vs. Dental Discount Plans
Dental Insurance Plan
You’ll find different types of dental insurance coverage, but a good plan will offer preventive, basic, and restorative dental care coverage. Your monthly premium allows you access to such high-quality dental care and treatments at affordable prices.
Certain preventive care services are 100% covered by the insurance from the start. You’ll have out-of-pocket costs for other services, but these extra costs are offset by the degree of coverage your plan offers. That helps you to afford those more expensive dental emergencies that may arise.
Dental Discount Plan
Certain dental care providers may offer specialized discount plans to their clients. But these discount plans are not insurance coverage. They offer discounted prices for dental services that you are paying for yourself.
There are certain advantages to these discount programs that dental insurance typically doesn’t offer. You won’t have to worry about any waiting periods or meeting any deductibles. But after the provider applies the discount, you will be 100% responsible for the costs.
Choosing The Best Dental Coverage
Choosing the best dental coverage is personal. Your needs and that of your family will differ from other people’s needs. Your budget constraints will also differ. That is why you must always consider your specific needs and budget.
Be Honest About Your Needs
Be realistic about your and your family’s dentistry and oral care needs. You could, for example, choose a dental plan offering preventive care only. It costs much less per month and, in some cases, is only half the price of a more comprehensive dental plan.
The problem is that these plans will not include coverage for fillings, extractions, or major dental work such as root canals. But if you don’t have many dental problems and only need preventive oral care, it might be the right dental plan for you.
If You’re On A Tight Budget
Lower premium plans can save you a lot of money every month. But generally speaking, lower premiums go hand-in-hand with higher deductibles, copays, or coinsurance. That is true of virtually all types of insurance.
If you don’t often need dental work done and need to keep your monthly costs low, choose a plan with lower premiums. Even though you will pay more out-of-pocket for those rare times you need more extensive dentistry, you’ll save overall. Preventive care may be 100% covered, too.
When Your Dental Needs Are High
If you experience regular dental problems or have children who need frequent trips to the dentist, your dental needs may be higher than most. In this scenario, rather than focus on plans with lower premiums, opt for plans that offer better coverage with higher annual coverage maximums.
You will pay a little more each month but have a lower deductible to meet before your coverage kicks in. You may also discover that out-of-pocket expenses, like copays or coinsurance, are now more reasonable.
Ask About Carried Over Benefits
You’ll probably find that most of the time, preventive dental procedures are all you’ll need throughout the year. You probably won’t even reach the plan’s annual coverage maximum most of the time.
But when you suddenly need a serious (and more expensive) dental procedure, you will reach it far more quickly. That’s why you should always ask if there’s an option to quarry over certain unused benefits to the following coverage year’s maximum. Some plans do this, but always check to be sure.
Is it worth buying yourself a dental insurance plan? If you want the peace of mind and financial security that comes with being prepared for anything, yes, it’s worth it. That’s the best advantage of any insurance plan, and it’s no less true for dental insurance.
However, beginners often become slightly bewildered when choosing the right dental plan. There’s so much to consider before you make your final decision. That’s where we can help. At Enhance Health, our consultants have the experience and expertise to help you find insurance that’s just right for you.
Contact us today, and we’ll help you find a dental insurance plan that makes you smile.