Dental insurance is designed to cover the most common problems in tooth and mouth care at different levels: from a simple check-up and cleaning to fillings and extractions to root canals. This type of insurance is not required by the Affordable Care Act (ACA) and functions independently: you can purchase iteven if you don’t have other insurance.
What Is Dental Insurance?
Dental insurance offers coverage for the most common tooth and mouth problems, from preventative treatment (check-ups, cleanings, x-rays, etc.) to basic care (molar extractions, fillings, etc.) to major surgery (such as root canals or gum treatment).
While it is not required by the ACA, dental insurance is a good supplement to your healthcare coverage. Just think about how many problems a small space like your mouth can generate: from something as simple as bad breath to tooth, nerve and gum pain, which can be very bothersome and significantly impact your eating habits, work and sleep.
Fillings, cavities, gingivitis, wisdom teeth, root canals, dentures, teeth whitening, etc.The list is long, and perhaps one of the main advantages of dental insurance is that it can provide you with preventative treatment that will ultimately improve your dental health and help avoid future problems. People who don’t have dental insurance will only go to the dentist when they have a problem. This pain or disease will then be more advanced and will require a much more expensive service. In contrast, the preventative treatment that comes with having dental insurance can prevent greater issues in the future and lead to major savings.
Did you know that cavities are still the most common chronic disease in children and adults even though they are easy to prevent? The National Health and Nutrition Examination Survey performed a study that collected a lot of illuminating data: for example, 92% of adults between the ages of 20 and 64 have had cavities in their permanent teeth.
What Does Dental Insurance Cover?
There are different levels of coverage depending on the services that will be performed. You should carefully read the terms and conditions of your policy to make sure that the service you want is included. This is particularly important for cases such as orthodontics, corrective appliances and purely cosmetic services.
Three Levels of Coverage
Preventative care for your teeth (check-ups, cleanings, routine x-rays, etc.) is covered by the majority of dental insurance plans. Depending on the plan and insurance company, the cost may be completely covered or might require a copay from you.
The most common types of basic care are fillings, extractions and non-routine x-rays, but the full list depends on each plan. We recommend that you carefully read the terms and conditions of your policy before purchasing it.
Root canals, crowns and bridges, among others. Many dental insurance policies do not include corrective appliances or orthodontics. If you are looking for dental insurance for this reason, make sure that the policy covers these types of services.
On the other hand, there are no age restrictions. There are dental insurance plans for everyone in your family: children, adults, and adults over 65.
Dental insurance is not a discount plan
You should be aware that dental insurance does not have anything to do with those dental discount plans you may have seen online. These plans are just discount coupons for specific treatments at specific clinics.
In contrast, dental insurance plans provide the full coverage that you and your family need, depending on your needs, and will provide you access to a network of dentists all over the country. The dentists in the network will take care of your teeth and save you money at the same time. And if you prefer a dentist who is not in network, that is also possible.
Types of Dental Plans
There are three main types of dental insurance, which have different features depending on the treatment they provide (keeping your usual dentist, list of services they offer, flexibility, cost, etc.)
- Health maintenance organization (HMO). With this type of insurance, premiums are lower and there is no annual maximum that the plan will pay. However, the network of available dentists is more restricted, and there is a list of copays you will have to cover for visits and specific treatments.
- Preferred provider organization (PPO). Premiums are higher than for HMOs, and there is an annual maximum amount the plan will pay. PPOs have an extensive network of dentists that have agreed to offer discounted services and will allow you to save money. They also offer some services if you choose a dentist who is out of network. The percentage covered by PPOs can vary depending on the service; the plan might pay 100% for a routine check-up, but only 50% for a bridge.
- Fee-for-service dental plan: These dental indemnity plans offer the greatest degree of flexibility. You will pay higher premiums, and there is an annual maximum for the benefit you receive, as well as a small deductible. These plans do not include a network of associated dentists, so you can choose whichever dentist you want and you will always receive the same benefit (though you won’t see the discounts offered by other plans that do have a network of specialists). Just like with PPOs, the percentage the fee-for-service insurance company will pay will vary depending on the service.
Frequently Asked Questions about Dental Plans
- Can I continue to see my usual dentist?
- Yes, but you will have to check that their name is on the list of professionals for the dental insurance you’re going to buy. The dentists who are in network have agreed to reduce their fees, so you will save more money if you stick to them.
- How does dental insurance work?
- If you’ve ever had health insurance, it won’t be hard to understand how dental insurance works. You pay a monthly premium for the plan. Beyond that, there are deductibles (which you pay before your company will pay for a service), copays (a fixed cost for a specific service, such as an x-ray) and coinsurance (a percentage of the service after the deductible; for example, if your coinsurance for a filling is 20%, and the filling costs $100, you will pay $20).
- Can I buy dental insurance if I don’t have health insurance?
- Yes. Dental insurance is a type of independent coverage. You don’t need other insurance in order to buy it.
- Is dental coverage included in the ACA?
- No. The ACA, also known as Obamacare, does not require dental coverage. In other words: you won’t be penalized if you don’t have this coverage. If you have children, the ACA mandates that you must be offered dental insurance, but you do not have to buy it.
- Are corrective appliances and orthodontics covered?
- Many dental insurance policies do not cover these services. If you are looking for dental insurance for this reason, make sure that the policy covers this type of service.
- Does dental insurance have a financial limit?
- Typically, dental insurance plans have an annual maximum (for example, $1000 per calendar year), though it depends on the plan and insurance company.