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Dental insurance is similar in many ways to traditional health insurance. When someone gets a dental insurance policy, it’s designed to cover a portion of the costs of dental care. There are different types of dental insurance plans, including individual, family, and group plans.
Around 77 percent of Americans had dental insurance in 2016, according to the National Association of Dental Plans.
The procedures covered by dental insurance are usually divided into three categories: preventive, basic, and major.
The majority of dental insurance plans will cover all the costs of preventive care, and most will cover the majority of basic procedures such as cavity fillings and routine tooth extraction. Major procedures like bridgework, implants, and major oral surgery may not be covered, or a patient may be responsible for more out-of-pocket costs with these types of care.
People often wonder if dental insurance is worth it, or if it makes more financial sense to pay out-of-pocket for all dental procedures. This is especially a concern, since many dental insurance policies may not cover the more expensive procedures at all.
Regardless of whether or not someone opts to purchase dental insurance, they should know most dental work isn’t going to be covered by their regular health insurance policy.
What Does Dental Insurance Cover?
The specifics of what dental insurance covers will vary depending on how much you pay in premiums. The higher the premiums you pay, the more coverage you’re likely to have.
Most dental policies will cover preventative care, fillings, crowns, and root canals. A dental policy will usually also cover oral surgery, like having a tooth extracted. Some plans may cover orthodontics and periodontics. It’s possible that prosthodontics could be covered under some policies, which includes bridges and dentures. Under most dental insurance policies, there is coverage for two preventative dentist visits annually.
Many dental insurance plans are a 100/80/50 structure. For preventative care, this means there’s 100 percent coverage, basic procedures are usually covered at 80 percent, and major procedures may be covered at 50 percent.
What Does Dental Insurance Not Cover?
All dental insurance plans will put a cap on what’s paid for each year, and that’s known as the annual maximum. Once you go beyond that cap, you’re responsible for all expenses. If you have a dental plan with a low cap — for example, $750 — once you go beyond that, you’re responsible for all other dental costs. Any kind of cosmetic procedure isn’t likely to be covered at all by a dental insurance policy. Cosmetic procedures can include:
- Teeth whitening
- Tooth shaping
- Gum contouring
There are issues of timing and how many procedures a person might have done in a year. For example, policies may cover two preventative visits each year, but they have to be done every six months only and they can’t be any closer together than that timing-wise.
Other time limitations can relate to how many X-rays are covered in a period of time, having fillings on the same tooth, or things like crowns and bridges on the same tooth. For children, there may be rules regarding how many fluoride treatments they can have within a specific time period.
Purchasing Dental Insurance & Average Cost
As with any insurance-related decision, it is a good idea to do comparison shopping before finalizing anything. Some factors to weigh when comparing insurance policies include:
- Think about the dental needs of everyone in your family. For example, do you have kids who might need braces?
- When you’re choosing a plan, you’ll want to make sure it allows you to pick from multiple care providers. Some plans may only have one dentist or one dental practice in your area, so you’d be very limited.
- While most routine treatments are covered in all dental insurance plans, as you compare, you want to look at what’s specifically not covered.
- Some dental insurance plans have waiting periods, and these can be lengthy in certain cases. For example, some dental insurance plans require a waiting period of up to 18 months before more expensive procedures are covered.
- You have to think about all of the costs when you’re comparing dental insurance companies. For example, you might first think about the premium, but there are also deductibles to consider as well as maximum yearly limits.
Most dental plans cost around $30 per month, but this only reflects one part of the costs you need to think about as you’re looking at plans. If your employer offers a group plan, this is more than likely going to be the cheapest option available.
Along with group dental insurance, you can also purchase individual group insurance, but this is the more expensive option. These plans are usually anywhere from $20 to $60 a month per family member. They may also have contracts and the longest waiting periods before the most costly procedures are covered.
Alternatives to Dental Insurance
Most people have dental coverage through their employer. There are other alternatives if this isn’t an option for you or if you’d rather not purchase dental insurance.
Self-pay is always an option, and you may do the math and find that’s less expensive than buying a plan. Where you live can play a role in not only how much dental insurance costs, but also how much dental procedures cost on average. You might also set up a health savings account geared specifically toward dental care.
If you are paying on your own, your dentist’s office may work with you on a payment plan, or they may offer a discount.
Non-Employer Group Plans
Some people may be eligible for group dental insurance plans not available through their employer but another organization. For example, AARP members can take advantage of group dental insurance through their membership in the association.
Dental Discount Plans
A dental discount plan isn’t the same as insurance, and you can’t use one with insurance. These programs offer an option to reduce what you pay on dental procedures, and it’s somewhat like being a member of a club.
Usually, with a dental discount plan, you’ll pay an annual fee. You might also have to pay an enrollment fee. These fees tend to be lower than what you’d pay for premiums on a dental insurance policy.
Then, you get a discount on dental services, but you’re going to pay more at the dentist’s office than you would if you had insurance. These plans do have networks, similar to insurance.
Although roughly three-quarters of Americans have dental insurance, that doesn’t mean it’s automatically the best financial choice for everyone. Before paying for a dental insurance policy, it’s important to identify your specific needs and what you’re currently paying for dental care, as well as what you might anticipate paying in the future.
You should carefully compare dental plans before choosing one, and in doing so, look beyond the premiums. You should also consider things like the maximum amount of coverage you would have in a year and whether an alternative might be cheaper than insurance in your particular situation.
Author: Ashley Sutphin