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Dental insurance plans offset the out-of-pocket cost of dental care. Different types of dental plans cover different services. These plans are available through a private dental insurance company or state-government funded programs.
Most dental plans cover at least a portion of preventative care and necessary procedures, and some offer even more coverage.
The most basic plans feature affordable premiums and provide coverage in emergencies so you don’t have to pay thousands of dollars if something goes awry with your dental health. Gold level plans have more expensive premiums, but you’ll pay less for extensive treatment.
Dental insurance covers preventive care for your oral health, including two teeth cleanings and one round of x-rays per year. Many insurance policies also cover part of the cost of fillings, root canals, dental crowns, tooth extractions, and wisdom teeth removal. In addition to this, they may partially cover orthodontics, such as braces, as well as dentures and bridges.
In general, there are four main types of dental plans:
Discount dental plans or cards are a popular choice for people looking for a budget-friendly option and have standard dental needs. These types of plans account for about 4 percent of all policies.
These plans are essentially membership programs. You join the plan and pay your membership fees and the return is savings on dental care costs. Most plans cover about 50 percent of your dentist’s fees.
Plans average about $10 per month per person and there are no waiting periods for coverage.
HMOs (Health Maintenance Organization) make up about 8 percent of all dental plans. This is an affordable option that still provides fairly comprehensive coverage. HMOs are available for a low monthly premium and usually require a small deductible ($50 or less). You pay a predetermined fee for all non-preventative dental procedures and preventative care is 100 percent covered.
The downside is you have a limited choice of dentists, so if your current dentist isn’t in the network, you’ll need to find someone new to enjoy all of the benefits of coverage.
PPOs (Preferred Provider Organizations) are similar to HMOs, but usually offer a wider network of dentists. This means your current dentist has a higher likelihood of being included in the plan. This type of dental plan makes up the vast majority of plans at more than 80 percent.
Under a PPO plan, you receive dental services at a reduced fee from dentists in the network. It’s important to understand what services are covered under your plan and choose a dentist that is within the network to enjoy the full package of dental benefits from a dental PPO.
PPO plans also allow you to choose an out-of-network dentist for your care. You will still receive some of the benefits, but the fees are likely to be higher than those of an in-network dentist.
Indemnity plans, sometimes called fee-for-service plans or traditional dental plans, account for about 6 percent of all types of dental plans. They tend to cost more than the other options. This is because they don’t require you to see an in-network dentist, so you won’t need to change dentists if you are happy with your current one. You also aren’t limited as to which dentist you can see under the plan, which is the most convenient option for many people.
With indemnity insurance, you pay an annual deductible. This means you are responsible for the services you need until you’ve met your deductible. So, for instance, if your deductible is $500, you’ll pay for all of the dental care you need up to $500 and then the plan will cover a portion of the costs of care.
In addition to the types of dental plans listed above, there might be other options available depending on your situation. These tend to be less popular options, but they work for some people. Less popular types of dental insurance plans include:
These plans make you pay the full cost of any dental procedure you need upfront. You then submit the receipt as proof of services and receive partial reimbursement for what you paid. These plans offer flexibility and let you choose your dentist, but not everyone has the funds to pay for the care they need upfront.
These plans give you the option of seeing an out-of-network dentist. You receive a certain percentage of reimbursement for the cost of your care. It is much less than the dental coverage offered if you choose an in-network dentist in an HMO or PPO plan.
This type of plan offers access to certain dentists and you have to receive treatment from one of these in-network dentists to be reimbursed for care.
This is a type of indemnity plan. They are different from traditional indemnity plans because you pay the difference between the procedure’s cost, the dentist’s fee, and what the plan covers. The contribution is the same regardless of how much the dentist charges for the service.
Finally, the government offers some dental plans. Most of the coverage is available only to minors and military families. Government dental plans include:
These programs are available for children under the age of 21 who are covered under Medicaid and CHIP (Children’s Health Insurance Program). There are some situations in which adults on Medicaid or CHIP also receive coverage.
Tricare is a dental insurance plan offered to active military service members and their families. It includes dental care coverage.
“Dental | TRICARE.” Www.Tricare.Mil, www.tricare.mil/CoveredServices/IsItCovered/Dental. Accessed 17 Aug. 2020.
“See How Health Insurance Coverage Protects You.” HealthCare.Gov, 2018, www.healthcare.gov/why-coverage-is-important/coverage-protects-you/.