Most dental insurance policies have a set number of preventive visits per year and time limits for other procedures. Some have a deductible and coinsurance payments as well.
DHMO plans tend to have lower annual maximums, but their provider choices are limited. DPPO plans have larger networks but usually have higher maximums.
Premiums
Like all insurance plans, dental insurance comes with a monthly premium that you pay to maintain your coverage. You may pay this cost directly through an employer-sponsored plan or individually on the Marketplace.
Like health insurance, a dental plan’s premium can vary depending on its coverage level, deductibles and copayments. For example, a plan with a higher deductible typically has lower monthly premiums.
Dental insurance premiums also change at renewal based on claims history and projected costs. Large employers can design a custom plan and negotiate rates with their carrier, while small business owners can choose from a pool of similar plans to keep premiums affordable.
Purchasing the right dental plan depends on your personal needs and budget. You can find plans that offer low or no deductibles, short waiting periods and high annual maximums on the Marketplace. Compare your options and get quotes from multiple providers to determine the best fit for you. Remember to factor in other out-of-pocket expenses, such as co-insurance and an annual maximum, when evaluating your plan’s costs. You can also consider a non-insurance option, such as a dental discount plan, to save on procedures.
Deductibles
In addition to deductibles and annual maximums, there are other factors to consider when shopping for dental insurance. These include copays and coinsurance, which are fixed dollar amounts or percentages of costs that must be paid by the insured before the plan starts to pay for care. Some plans have both, while others only have one or the other.
Deductibles vary from plan to plan, as do coverage limits. For example, a DHMO may not have a deductible at all, while a DPPO usually does have one.
Some plans have family deductibles that must be met before the plan will begin to pay for services. Other plans have individual deductibles, which are applied to each member of the household until the total amount of individual deductibles is reached. Once the deductible is satisfied, most plans will cover basic services at 80% of the cost, with the insured responsible for the remaining 20%. In addition to deductibles and annual maximums, dental plans can also have limitations and exclusions on which treatments are covered. These can include things like frequency limitations (for example, some plans only cover two cleanings per year) and exclusions (for example, orthodontics are not usually covered). These limits can be a big factor in choosing the right plan for your needs.
Co-insurance
Like any other type of insurance, dental plans come with different premiums, deductibles and annual coverage maximums. The key is to find a plan that best suits your needs.
If you’re looking for a low-premium plan with short waiting periods and high annual coverage maximums, consider a preferred provider organization (PPO) or dental health maintenance organization (DHMO) plan. PPO plans have networks of dentists that offer discounted fees for dental services. You can choose to visit out-of-network dentists, but you’ll pay more in most cases.
DHMO plans typically have lower premiums than a PPO but they also require you to stay in-network for all non-preventive care. Many DHMO plans have a fixed copayment for basic procedures, such as fillings or extractions, and a fixed percentage coinsurance for major services, such as crowns, root canals, and bridges.
Another option is a traditional or indemnity dental insurance plan, which has no network and lets you see any dentist. The plan will reimburse you a percentage of the procedure based on what’s called “usual, customary and reasonable” (UCR) charges.
Exclusions
In some cases, dental insurance plans will exclude certain services, or only cover a portion of the cost. These types of limitations are common, and can vary between insurers. Most insurance policies will have a section that lists the types of services covered and the limits on coverage. Typically, these limitations are based on the type or number of procedures, age, or frequency of visits.
Many dental insurance plans will also include a waiting period for specific treatments, such as crowns, root canals, and oral surgery. These can range from a few months to up to a year. This is intended to prevent people from buying insurance in response to a sudden need for major treatment.
Another limitation is the maximum allowable charge, or MAC. This is the fee that an insurance company will pay for a given procedure, and it is usually less than what the dentist charges. Some insurance companies also use negotiated fees, which are the amounts that in-network dentists have agreed to accept as payment in full for their services.
Benefits
Dental insurance helps offset the cost of dental care. Policy holders pay a monthly premium, often deducted from paychecks, to access the benefits of their policy. Like other types of coverage, dental policies can have deductibles and annual or lifetime coverage maximums that must be reached before the insurer starts to reimburse for treatments. The insurer will also specify which dentists are in its network and the amount it will cover for care outside of the network.
Most experts recommend adults visit their dentists at least twice per year for preventive visits. The amount the insurer will reimburse for these services is typically tied to a schedule that can be found in the plan’s benefit booklet. Consumers should review these benefit booklets to ensure they are fully informed about their options. Those looking to buy dental insurance can compare the plans available in their area through an online search. Many companies offer group dental coverage to their employees with affordable rates and a large provider network. Dental insurance is a popular employee incentive, and employers can also add vision and disability coverage to the package.