Dental Insurance

All dental insurance plans are designed to provide significant savings on preventive dental procedures but with a basic dental insurance plan, you are covered only for preventive care, which is covered at 100%.  That means you don’t have to pay a penny out-of-pocket for essential services such as regular dental checkups, cleanings and a set of bitewing x-rays.

Other preventive services, depending on your insurance plan, may include flouride application and dental sealants for children to prevent dental decay, and perhaps mouth guards and other non-orthodontic oral appliances.

That’s it!  You don’t get coverage for fillings, extractions or deep cleanings.  Most dental insurance plans do cover these sorts of treatments at 80% of the cost.  You also don’t get coverage for root canals, crowns, bridges, dentures for orthodontics. Typically, denture insurance covers 50% of the cost of the services (20% for braces). If your basic insurance plan does cover more than preventive care, that coverage will be extremely limited and will likely have significant restrictions regarding wind, how often and from whom you can get dental treatment.

Why Get Dental Insurance?

Most people who have basic dental coverage got their insurance as part of their job benefits package, Or as a free ad on to their health insurance plan. When you have healthy teeth and gums, getting free checkups and cleanings twice a year or so is a great deal – Especially when you aren’t paying anything for that insurance plan.

Another benefit of some basic dental insurance plans is that you may get a discount on other types of dental treatments – But only if you see dentists who are in your provider’s network. Dental insurance providers typically negotiate lower fees with in-network dentist, and anyone covered by a plan – Even the most basic plan – From that provider kids clothes reduced rate. How much of a discount can you expect? That varies by plan, but it’s usually between 10 and 20%.

What Kind of Dental Insurance Covers Everything?

Sadly, there is no type of dental insurance that covers “everything.” Most will not cover treatments for dental problems that you have prior to joining the plan, and many do not cover dental implants or cosmetic treatments. Dental savings plans, an alternative to traditional dental insurance, typically do cover care for existing dental issues as well as dental implants and cosmetic procedures.

What is a Fee Schedule?

A fee schedule is a list of dentist’s rates for various treatments. When used in reference to dental insurance or dental savings plans, the fee schedule will also list the plan holder or dental savings plan member’s reduced rates for dental care. Check fee schedules of any dental insurance or savings plan that you are considering to see how much money you can save on dental care.

What is a Treatment Plan?

This is a document that details what dental treatments you need, the ADA billing codes associated with those treatments, and the costs of the treatments based on whether you will pay out of pocket, with a particular insurance plan or with a dental savings plan. Compare the costs listed on your treatment plan to those listed on an insurance or dental savings plans’ fee schedule to see how much money you may be able to save.

Can I Buy Dental Insurance Today and Use It Tomorrow?

If you purchase a DPPO plan you may be able to use it immediately for a checkup, cleaning and basic x-rays. For anything outside of preventive care, you’ll need to wait for 3-6 months for basic care (fillings, extractions) and 12-24 months for major restorative care. If you were previously covered by dental insurance for a year prior to purchasing a new plan, you may be able to get the waiting period waived – ask before you purchase the new plan.

If you have an DHMO plan, there will probably not be any set waiting periods, but you may not be able to be seen by your in-network dentist immediately and your plan may limit how frequently you can get various types of care.

DHMO Dental Insurance Plans

DHMO plans tend to be less expensive – and less flexible –  than DPPOs. With a DPPO, you don’t have an annual maximum spending limit, and you’re covered for dental care right away. You must see an in-network dentist who will be your primary provider (and it can be hard to switch dentists), you’ll need a referral to see a specialist, and there may be limits on when and how often you can get treatments.

DPPO Dental Insurance Plans

DPPO plans are widely accepted at dental practices nationwide, and although you’ll save more with in-network dentists, you can go out-of-network if you choose.  Most DPPO plans don’t require referrals before you can see a specialist. There is an annual deductible of $50-$100, and the typical annual maximum coverage limit is $1000- $1500. If you reach your spending limit, you’ll need to pay for your care out of pocket for the rest of the year. DPPO plans have waiting periods before new members are covered for all basic and major dental procedures. Typically waiting periods can be 6-12 months, but in some cases can extend to two years.