Finding and choosing dental insurance has never been easier!
Dental insurance is an essential part of maintaining your overall health, yet many people tend to overlook its importance. Worries about expenses and misconceptions about its necessity can turn people off from enrolling in a plan.
A staggering 68 million adults in the U.S. do not have dental insurance, according to the CareQuest Institute for Oral Health. Additionally, the ADA Health Policy Institute reports that 12 percent of children go without dental coverage. This leaves people either paying for dental services out-of-pocket or skipping dental visits altogether.
Whether you are unsure about the value of dental insurance or actively seeking a plan, you likely have questions. Here you will find the most common questions and answers to help you navigate your dental insurance options wisely.
Dental insurance plans focus on specifically on addressing dental issues, covering diagnostic/preventive, basic, and major dental services.
You may be wondering why medical insurance doesn't cover dental health, considering the mouth is part of the body. The dental and medical fields have traditionally been separate, with different schools, offices, and insurance coverage.
While some medical insurance plans offer limited coverage for necessary dental services related to a medical condition or injury, the extent of coverage can vary among plans and providers. It's crucial to review the specific details to understand the covered services and any limitations or exclusions.
Dental insurance provides coverage for:
Consider your specific needs when selecting dental insurance. You may require coverage for implants or braces, so make sure to choose a plan that meets your individual requirements.
Dental insurance is commonly offered by employers as an option along with medical and vision insurance. It is also available through Medicaid for children under age 21 and for some adults depending on the state they live in.
For those who do not have access to dental insurance, purchasing your own coverage has become more convenient with online exchanges. Federal and state exchanges, established by the government, allow individuals and small businesses to compare and secure health insurance. It is important to note that insurance can only be purchased on these exchanges during specific enrollment periods or due to a qualifying life event such as loss of coverage or birth/adoption.
In addition to government exchanges, private exchanges operated by insurance companies offer the option to purchase dental insurance at any time during the year.
Different dental plans are available, depending on the insurance provider you choose. Here are the most common dental plan types:
Depending on the service type and the dentist's agreed fee, you may be responsible for a larger portion of the treatment cost compared to traditional dental insurance.
Traditional dental plans offer coverage based on deductibles. A deductible is the amount you pay upfront before your dental insurance kicks in to help cover costs. For instance, let's say you have a $50 deductible - once you've paid that, your dental plan will start covering 50% of your remaining expenses. The deductible is different from the premium, which is the fee you pay to have the insurance plan.
Additionally, traditional dental plans have an annual out-of-pocket maximum. After you've met your deductible, there's a limit on how much your insurance will pay for dental services each year. For example, if there's an annual cap of $1500 and your plan has already paid that amount, any additional services will be paid out of your own pocket.
Understanding the ins and outs of your plan's deductible and out-of-pocket maximum is key for financial planning. This knowledge will help you be better prepared and make the most of your dental insurance.
Not all dentists and dental specialists work with insurance. Providers have the option to choose whether they accept insurance rates for their services. If they are out-of-network, it means they do not accept your dental insurance, and you will need to pay for services out-of-pocket.
There are various reasons why dentists may opt not to accept dental insurance. It could be due to not agreeing with the policy and paperwork requirements from the insurance provider. Some dentists may prefer direct payment from the patient rather than accepting the fees set by the insurance company.
When selecting a dental plan, it's essential to look for your preferred dentist or explore other dentists in your area. Visiting an in-network provider will result in the lowest cost for your dental services. While some dental plans offer out-of-network benefits, you will typically pay more for each service.
When selecting dental insurance, it's important to check if you can use it right away or if there's a waiting period involved. Some plans may require you to wait before receiving coverage for certain treatments.
Waiting periods also apply to the frequency of care, such as checkups and cleanings. It's worth noting that not all insurance providers have waiting periods, so be sure to review the details when exploring or enrolling in a dental plan.
Keep in mind that the waiting period differs from the effective date, which marks when your insurance policy becomes active. Typically, this date falls on the first day of the month following your application and payment completion.
Securing dental insurance coverage for retirement can be quite a challenge. Not all employers extend dental benefits into retirement, and Medicare only covers medically necessary dental services. Thankfully, there are dental insurance plans tailored to meet the needs of seniors and retirees.
Retirees have the option to explore dental insurance plans available through state and federal exchanges, as well as private exchanges. It's important to carefully review plan details to find one that aligns with your needs and budget.
Whether you require preventive care like cleanings, common procedures such as fillings, or more extensive treatments like root canals, crowns, or dentures, there are plans that can cater to your specific needs.
Don't forget to consider the financial aspects, including copayments, deductibles, and any potential waiting periods for certain services. If you already have some dental coverage through your retirement package, you may simply need supplemental coverage, such as a Dental Savings Plan.
When enrolling in or searching for dental insurance, it's important to consider the costs and your specific needs. For routine checkups and cleanings, a basic dental plan may suffice. For planned procedures, you'll want more comprehensive coverage. Keep in mind that unexpected services may also require dental coverage.
Typically, dental insurance plans cover a percentage of different services, leaving you responsible for the remaining cost. In this case, we will focus on dental plans with a deductible. Services are categorized as diagnostic/preventive (plans pay 100%), basic (plans pay 80%), and major (plans pay 50%).
Individual dental insurance plans can usually be canceled at any time by simply discontinuing your premium payments. It is recommended to reach out directly to your insurance provider to initiate the cancellation process.
If your dental coverage is part of a bundled health insurance plan, you will need to wait until the open enrollment period to make any changes or cancellations, unless you experience a qualifying life event (such as a new job, birth/adoption, marriage, etc.).
People have the option to utilize multiple dental insurance plans to cover their services, a process known as Coordination of Benefits (COB).
For instance, when spouses are covered by insurance plans through their employers, the primary insurance plan is typically the one where you are the employee or main policyholder. The secondary plan is the one where you are enrolled as a dependent.
It's important to note that coordination of benefits does not equate to having double the coverage. Instead, if both of your dental plans support coordination of benefits, they will collaborate to help decrease your out-of-pocket expenses.
Download our dental plan selection guide to learn how to match a plan to your health care needs.