Dental Insurance Questions Answered
Regular visits to your dentist can improve your dental health and if you have coverage, you’re more likely to visit your dentist. Those visits can help prevent and monitor dental health issues that could lead to more serious conditions and require more expensive treatment, such as cavities, tooth removal, root canals and even oral cancer.
The good news is that patients in Idaho and Oregon have more choices for dental coverage than ever. It’s important to know all your options when choosing the right dental plan for you and your family. Use this buying guide to get started—and get covered.
For some people, buying dental benefits may cost more than paying a dentist’s office directly. When considering a plan—especially if it’s not provided through your employer—ask yourself the following questions to estimate how much you might spend out-of-pocket:
• What is your plan premium?
• What is your plan’s deductible?
• What is your co-payment?
• What percentage of treatment costs (coinsurance) will I pay?
Start With Your Dentist
When you consider the total cost of your dental treatment, you must remember to include the cost of the dental plan itself. Another important factor to consider is what kind of care you regularly receive from your dentist. Are your regular checkups enough, or do you routinely need procedures (like cavity fillings) performed? Talk to your dentist about your dental history and possible care needs before making your decision.
Because your health is always changing, revisit these conversations with your dentist before your policy is renewed each year, or when it’s time for you to choose your benefits at work when you’re hired or during open enrollment. Notice that we have used the term dental benefit plan and not dental insurance. Insurance plans are designed to make you whole in the event of a loss. Insurance, by definition, entails a risk of loss to the insurance company. Typical dental benefit plans are not designed to cover all dental procedures, and dental benefits coverage is not based on what you need or what the dentist recommends.
Dental benefit plans are not designed to cover all dental procedures. Plans usually cover some, but not all, of your dental costs and needs. Many plans involve a contract between your employer and a dental plan, but you can also purchase individual plans on your own or through the Health Insurance Marketplaces.
Your dentist’s main goal is to help you maintain good dental health, but not every procedure your dentist recommends will be covered. To avoid surprises on your bill, it is important to understand what and how much your plan will pay.
Which dental plan or insurance is right for you?
Sorting through different dental plans can sometimes feel overwhelming. Get a breakdown of your options, and find out which one is best for you.
Preferred Provider Organization (PPO)
A PPO is a dental plan that uses a network of dentists who have agreed to provide dental services for set fees. The number of dental services covered depends on the plan. If you have a PPO plan and see a dentist out of the network, you will most likely have more out of pocket expenses.
Dental Health Maintenance Organization (DHMO)
A DHMO is like an HMO. Network dentists are paid a set fee every month to provide covered dental services to you whether you see the dentist or not. Typically, some of the covered services have no cost to you, or you may have to make an out of pocket payment for the service.
Discount or Referral Dental Plans
Discount and referral plans are technically not benefit plans. The company selling the plan contracts with a group of dentists. These groups of dentists agree to discount their dental fees. Discounts are usually applied to all services including cosmetic. These plans do not pay for any services received, instead, you pay the full cost of treatment at the reduced rate determined by the plan.
Not all employers offer dental benefits. If you’re struggling to find affordable dental coverage, here are some places to start.
Ask Your Dentist
Some dental offices are starting to establish dental membership savings plans. Typically, these plans charge you a fixed dollar amount on an annual basis and cover certain procedures at no additional charge (for example, cleanings and exams). After that, other procedures are discounted. Ask your dentist if he or she offers such a plan.
From Your State
Assistance programs vary from state to state. Contact your state dental society to find out about care in your area.
The Affordable Care Act
The Affordable Care Act extends health insurance to millions of Americans, most importantly guaranteed coverage for your children. Although the new act does not require dental coverage for adults, some state marketplaces may also offer dental coverage for adults. Learn more at Healthcare.gov.
Oral Health America
Are you over 60 or the caregiver of an older adult in need of dental care? Visit ToothWisdom.org for a list of the resources available in your state.
Children’s Health Insurance Program
The Children's Health Insurance Program (CHIP) provides free or low-cost health coverage for more than 7 million children up to age 19. CHIP covers U.S. citizens and eligible immigrants, as a government Medicaid program.