30 sec brief
We all know that having health insurance is important. What about dental insurance? Do we need it too? Dental insurance works differently than health insurance, and for some people, it makes a lot of sense to have it.
We all know that having health insurance is important. What about dental insurance? Do we need it too?
Dental insurance works differently than health insurance, and for some people, it makes a lot of sense to have it. As with any type of insurance, it’s vital to take a look at your personal situation and decide if purchasing coverage is a good choice for you.
Dental insurance focuses on preventive care. Dental insurance plans focus on preventive care, to catch anything before it goes awry.
For those who have seemingly healthy teeth and practice good oral hygiene, it may seem unneeded. However, the teeth have a way of tricking us. While all may seem well, cavities could be forming, or other oral health issues may be sneaking up.
For those who go without dental care due to lack of insurance, or not being able to afford the out of pocket expense, once they return, may find themselves with a few cavities or other oral health issues that need fixing.
As many dental insurance plans cover cavity fillings and help pay for other services and procedures you may need, it may be worth looking into dental insurance.
In addition, knowing you’ve paid for the insurance may encourage you to get those checkups and keep on top of your oral health.
What does the monthly dental premium cover?
Dental plans usually offer what is known as 100/80/50 coverage which includes:
- Preventative care – the services you receive during a typical dental checkup – the exam, cleaning, and X-rays are 100% covered. Dentists recommend cleanings every six months, or twice a year.
- Basic procedures – such as extractions, fillings and periodontal work are 70% – 80% covered.
- Major procedures – like root canals, crowns, implants, bridges, dentures are usually covered at 50% and sometimes less.
Of course, each plan varies, so it is essential to read the fine print.
Orthodontic care is not usually covered under most dental plans, so some plans offer separate coverage. Keep in mind that services like teeth whitening, are generally not covered under dental insurance and are an out-of-pocket expense.
What types of Dental Insurance are there?
Dental plans usually fall into one of the following three categories:
Preferred Provider Organization Plans (PPOs) – A plan that allows you to choose any doctor you want. The catch is that you will pay more if you select out-of-network doctors.
- The good – these insurance networks often pay more than with an HMO or indemnity plan. You don’t “have” to see in-network doctors.
- The bad – If you choose not to see an in-network doctor, you’ll pay more. PPO plans typically have an annual maximum reimbursement limit. Some procedures may have a waiting period or may not be covered.
- Why choose a PPO – You like the ability to choose your dental provider. Also, If you don’t need major dental work right now but want to be prepared for the future, a PPO may be a great choice.
Health Maintenance Organizations (HMOs) – A plan type that covers only services offered by health care providers within the network. HMOs are considered one of the most affordable options as they tend to have low premiums.
- The good – Preventive services such as annual cleanings and x-rays will be covered 100% by the plan. Basic procedures will have a copay. In addition, you may not have a deductible or annual maximum limit. Your premiums may be lower.
- The bad – Not a lot of choice in providers. Major procedures are often covered at less than 50% and sometimes not at all.
- Why choose an HMO – You don’t have a provider preference. You don’t think you’ll need any major dental procedures any time soon.
Indemnity or fee-for-service – A plan type that lets you choose a dental provider and pays a percentage of the provider’s fee.
- The good: Pros: Wide variety of providers. Deductibles have a tendency to be lower than other plans. Sometimes, the annual maximum coverage amount is higher. These plans give you the most choices of providers.
- The bad – Monthly premiums are usually higher than other plan types.
- Why choose an Indemnity Plan – You have a specific provider you want to see. You have some major costly procedures coming up soon.
What happens when you need major dental care?
The truth is, with or without dental insurance, you’ll have to pay some money. If you think about it, we use our teeth multiple times a day, at some point they’re going to need some care.
As each dental insurance plan has a maximum annual limit, you’ve got to consider your upcoming dental needs. The annual maximums can be quickly met when you get into major and restorative procedures. For example, crowns cost anywhere between $750 and $1200, and dental implants usually start at $1500 (over many plans annual maximum limit).
If you decide to get insurance, you’ll want to purchase your policy before, rather than after, finding out you need major dental work. If not, you may find yourself waiting months for coverage to begin.
So, what do you do if you’re uninsured and need major dental work now?
Talk to your dentist. If the dental work needs are immediate, be prepared to pay for the procedure out-of-pocket. Many dental offices offer generous payment plans to ensure you can have the procedures you need.
Take time to consider your overall oral health picture to help decide if dental insurance is a good choice for you. Be sure to schedule those dental checkups to keep your mouth in tip-top condition.
About the author
Vicky Warren, once a nurse, now a freelance healthcare writer and social media coach.