Dental Insurance 101: Everything You Need to Know

No one likes going to the dentist.  Sometimes the bill can be even more unpleasant than the treatment.  Is dental insurance even worth it?  How do you get the best dental insurance for your needs?  We get asked about dental insurance a lot!  To many people it seems like options are limited, information is very confusing, and, at the end of day, their services are still astronomically expensive.  Even if you have dental insurance offered by your employer, it is very important that you are informed to ensure you have coverage that matches your needs.  


Should I Take the Dental Insurance Offered By My Employer?

You may already have insurance through your employer.  It may not have even crossed your mind to look into alternative options.  However, you might want to consider it!  If your dental needs are usually limited to the basics and your employer offers the usual 100/80/50 PPO plan, you may save a couple of dollars by sticking with your group plan.  However, even without group insurance, dental insurance can be pretty inexpensive.  Plans usually range from $15-$50 per month for a single individual.  Compare that to the plan offered by your employer.  If you choose to purchase a separate plan, you will have more choice in providers and plan type.  As always, we suggest that you do your research and comparison shop.  


What’s Covered?

A good dental PPO usually offers the 100/80/50 split.  100% of your preventativedental insurance smile services will be covered.  80% of your basic services will be covered.  50% of your major services will be covered.  You can see the exact breakdown of costs in your plan’s brochure.  Generally speaking preventative services cover routine screening, cleaning and xrays.  Basic services consist of fillings, root canals, and extractions.  Major services (the expensive stuff) are crowns, bridges, and implants amongst others.  Usually orthodontics is not part of a basic dental plan, but you can often add on orthodontic services for an additional fee

At face value, it sounds pretty straightforward.  However, PPO dental plans also have maximums.  Usually these maximums are somewhere between $1000-$2000.  Once you have reached that cap, you will be on your own for any remaining expenses.  DHMOs offer specific copays for each service and often don’t have maximums, but there can be downsides as well.     


Where Can I Buy Dental Insurance?

You can purchase dental insurance on or off the marketplace.  To enroll in insurance through the marketplace, you must do so at the same time you enroll in your health insurance plan.  Open enrollment is every year from Nov. 1-Dec. 15 (although some states offer extended enrollment periods).  For a marketplace plan, logon to healthcare.gov to see all of your options.  Additionally, you may be able to enroll during a special enrollment period if you qualify. 

Should you choose to enroll in a plan off the marketplace, you can do so year round.  For off marketplace plans you will need to deal either directly with the agent of a carrier or through a broker.  Because brokers represent you, not the insurance company, we recommend working with a broker to ensure you are able to effectively comparison shop.  Many brokers will not charge you for their services.    


How Much Does Dental Insurance Cost?

Most dental insurance plans will run you between $15-$50 per month.  You’ll also be responsible for your portion of covered services.  Most PPO plans cover 100% of preventative services, 80% of basic services and 50% of major services.  You still need to check with your dentist to determine your exact costs.  Fees for the same services can swing widely even from county to county.  For example, a root canal for a molar can range from $500 to $2000.  That’s a pretty wide range!  So, if you’re flexible with your choice of dentist, you can certainly ask for prices and get a second opinion to make sure you’re not paying more than need be. 

Additionally, most plans will only pay up to $1000-$2000.  After you have reached that cap, you will be on your own for any additional expenses!  Luckily, most plans don’t count preventative services towards these maximums.  There are also plans with much higher maximums.  

With DHMOs you will only be covered with in network dentists, but your copays are set.  This makes determining your costs much easier.  Both  DHMOs and PPOs may have a deductible you need to meet before your insurance kicks in.  


PPO vs. DHMO vs. Indemnity Plans

There are several different types of plans to choose from. You’ve probably heard of PPO’s and DHMO’s (dental health maintenance organizations), but you may not have heard of Indemnity plans.  PPO’s and DHMO’s work very similarly to the way their health insurance counterparts do. 

HMO’s have lower monthly premiums, but you must use an in network dentist.  PPO’s have higher monthly premiums, but you have more flexibility with dentist choice.  If you use an out of network dentist, you will still have coverage, just less so than with an in-network dentist.  Additionally, DHMO’s require a “preferred” physician who must coordinate all visits with specialists.  PPO’s do not.  Also, some people report dissatisfaction with dentists in their DHMO networks.  Because DHMO dentists must see a certain amount of patients, many patients feel rushed through their appointments and prefer the services of dentists that operate on a PPO.  Of course, this is not true of all dentists.  Some people absolutely love their in network DHMO dentist.  PPO’s may also require more paperwork and reimbursements which can be a headache!

Then there are Indemnity Plans (also known as fee for services plans).  These plans offer ultimate flexibility in the dentists and specialists you see and the coverage offered.  Additionally, indemnity plans have much higher annual caps, so if you need extensive work, this may be a plan to pursue.  However, these types of plans have higher monthly premiums and higher deductibles.  You also have to pay upfront and then complete a large amount of paperwork before being reimbursed.  


I Need Major Dental Work Now!

dental insurance chairUnfortunately, many of us wait until we’re in pain to think about the dentist.  Additionally, most plans have a 12 month waiting period for major services, which is far too long if you’re in pain now.  If you need major dental work now, you may have options! 

If you currently have dental coverage (but it’s just not great coverage), you may be able to switch to a more appropriate plan and skip the waiting period.  Nationwide is a great example.  You can get a plan with up to $5000 annual limit which can save you thousands if you have large dental expenses.  You can also view the plans available here

If you don’t have coverage, there are actually plans that will cover major services as of January 1st the following year.  So, if it towards the end of the year, you can enroll and wait just a few weeks before you have full coverage.  If neither of those options work for you, you can look into a discount dental plan (also known as a dental saving plan) for some major discounts.  However, the network is usually rather limited.  If all else fails, many dentists offer discounts for those paying cash and there are community health events and dental schools.

If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-918-0518 or schedule a call today!  There is absolutely no charge for our services and we will happily guide you towards the right plan for you.  

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Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.

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