Learn about different types of insurance.
Learn about coverage, deductibles, and costs.
Learn about what procedures are covered.
Helpful information on things to consider.
Find out how much a dental visit will cost.
How much value does insurance provide and what are the alternatives.
What are different plan types of dental insurance?Learn about different types of insurance.
When looking at health insurance, you may come upon plans that say HMO, PPO or EPO. It’s important to know what these types of plans mean before signing up for one. These plans all use a big network of dentists. The only difference is how you interact with them. Most HMO, or Health Maintenance Organization, plans require you to choose a primary care physician, who will determine what kind of treatment you need. HMO plans usually have the lowest costs. Dentists outside of an HMO network will charge you for the full amount of the procedure. PPO, or Preferred Provider Organization, is a type of health insurance plan that doesn’t require you to choose a primary care physician. Like HMO, a PPO plan also has a large network of providers, but if you decide to see a dentist outside of the network, you will pay less, since the dentist will be compensated by the insurance company. Next, EPO (Exclusive Provider Organization) plans are the ones that combine HMO and PPO. It means you don’t have to seek a primary care physician, but unless it’s an emergency, the plan doesn’t cover costs for dentist outside the network. Finally, you may find indemnity dental insurance. Also called traditional dental insurance, indemnity insurance has the highest premiums, but the pros are that the deductible is very small or even nonexistent, and there is a large selection of dental offices to choose from.
The Basics of Dental InsuranceLearn what a deductible is, how copay works, and common terminology associated with dental insurance plans.
Deductible is the amount of money you have to pay before your dental insurance pays for anything. In order for your insurance to pay for any additional costs, you will have to pay the deductible out of your pocket.
Coinsurance is percentage of money you have to pay after you pay the deductible, and after the insurance has covered a part of the bill. How much money the insurance will pay depends on your plan, but can range from 20% to 80%. You will have to cover the rest of the bill.
Copay is very similar to coinsurance, where you have to settle costs together with the insurance company after paying the deductible. The only difference is that instead of a percentage, you have to pay a set amount of money.
Maximum is the amount of coverage in a year that your dental plan will pay for your procedure. After you reach your maximum on your dental plan, you will be responsible for settling all the remaining costs. In most cases, if you pay more for your policy, then your maximum will be higher.
Reimbursement levels are different categories in your dental plan, which cover certain procedures. Preventive or diagnostic procedures are usually fully covered, meaning you are encouraged to get regular checkups. By seeing the dentist on a regular basis, there are fewer chances a dental emergency might occur. Basic procedures, such as fillings and root canals, are covered at a lower percentage, while major procedures have the lowest percentage. These procedures include dentures, bridges, and crowns.
Waiting period is the amount of time you have to wait until you can start having dental work. Insurance companies wouldn’t make much money if they would let you have a major procedure right after signing up for a new dental plan, so they make you wait with fixing your teeth until you are paying for their policy for a certain amount of time. It is not uncommon to wait longer than a year for any major work on your teeth.
Pre-treatment estimate is a way to predict how much money you will have to pay out of your pocket for your procedure. By having a dentist do an estimate, you can see the total cost of the procedure you need, and how your dental plan will affect your deductible and coinsurance.
What does dental insurance cover?Dental insurance covers a range of procedures.
Dental insurance is not too much different from medical insurance. While both dental and medical insurance cover costs after you pay the deductible, dental insurance has an annual limit. Any costs higher than the annual limit will have to be met by the patient. According to the National Dental Insurance, only 2% to 4% of Americans reach their maximum limit. Usually this limit is between $1000 and $2000. You can quickly reach your limit even if you don’t get a major treatment like a bridge or a crown, which on average costs $700-1200. Typical dental insurance plans offer a 100-80-50 coverage. Since preventative care is important, the insurance will pay for 100% of preventive and diagnostic procedures. This is one of the biggest pluses of insurance, because it encourages you to get your teeth checked on a regular basis. The cost of fillings or root canals, which are considered basic procedures, will also be covered by the insurance, but at a lower rate of 80%. The insurance will also cover 50% of expenses for major procedures, such as crowns. While dental insurance covers all these costs, you need to make sure that your dentist is in your insurance’s network. Otherwise, you will be paying for the full cost of the procedure you need.
What to consider when choosing a dental plan?No matter what kind of dental plan you want, you should first ask one of the following questions.
Is my dentist in the network covered by the insurance?
PPO and HMO plans limit the choice of dentists you can see, so your family dentist might not be in those networks. Instead, you might have to choose one of the dentists in the insurance’s network.
Can I get group coverage?
Group plans are usually less expensive than individual insurance. Not only that, but they often have better benefits as well. You just need to make sure that you have read all the details about the group plan, because an individual plan may suit your needs better.
What does my insurance policy cover?
Not all insurance plans are the same. This especially refers to the waiting period. You have to know that the insurance company won’t let you sign up for their plan, then get some major work done the next day. The waiting period, or the time you have to wait to get a procedure done, will be from six months to two years, depending on the severity of the procedure. In most cases, procedures like fillings or root canals, can be done right away, but it’s different for crowns and gum-disease treatment.
How to estimate dental costs/expenses?Learn about common dental emergencies and treatments.
Aside from dental cost calculators, which only show you the cost of a procedure without your insurance plan, there are other ways you can estimate how much a trip to the dentist will cost. If you are sure what kind of dental procedure you need, you can always make a phone call to a dentist near you and ask about the price. Prices may vary greatly, depending whether you live in a big city or countryside. Dental Optimizer1 is a website with a very good dental cost calculator, and can show you prices per state for any procedure you might need for your teeth. For average costs with and without insurance in the US, we have created a table, with the information from Cost Helper2.
|Procedure||Cost With Insurance||Cost Without Insurance|
|Teeth cleaning||Completely covered||$127|
|Cavity filling||50-80% of the cost||$204|
|Wisdom tooth removal||$416||$250 - $750|
|Root canal||Front tooth $608||$1156|
|Back tooth $333||$957|
Is dental insurance worth the cost?Here is some information about how dental insurance saves you money.
According to the National Association of Dental Plans, about 77% of Americans have dental insurance3, whether it be private coverage, or through a publicly funded program. Not buying insurance, and flossing your teeth every day might do the job, but it’s unlikely you will not have any problems with your teeth in the future. While preventive care is important, you will need much more than just routine cleanings. This is where dental insurance comes in handy. Most plans offer you free checkups and cleanings twice a year, and just that alone will make you break even on the premium you’re paying. Everything else, like root canals or fillings, will only save you money. Even if you’re not interested in breaking even with your cleanings, dentists advise you to go for a checkup at least twice a year to prevent any dental emergencies later on.
What are the alternatives to dental insurance?Take a look at some other ways to pay for your dental costs.
If you think you cannot afford or you don’t need dental insurance, there are many alternatives to it besides paying straight out of your pocket. Preventive care always comes first. Brushing your teeth two to three times a day, flossing after eating, using mouthwash, and even avoiding certain acidic foods or carbonated drinks, can let you be dentist free for some time. Going to dental schools or charitable clinics, or even health centers with government funding, will help you cut down costs. If you live in a big city, you might want to go to a small town nearby to get your procedure done, because dental costs in cities can be much higher. Finally, if there’s an expensive treatment you need to get, you might want to consider going out of the country to get one. Dental tourism is becoming more and more popular because of lower prices than in the US, but the same quality.
List of Top Insurance CompaniesFind the right insurance company for you, and purchase a plan directly on their website.
|Blue Cross Blue Shield|
|Spirit Dental & Vision|
List of Top Discount Dental PlansBrowse through discount dental plans, and find the right choice for your emergency dental needs.
|Discount Dental Plan Providers|
|Aetna Vital Dental Savings|
- National Association of Dental Plans (2017). Who Has Dental Benefits Today? Retrieved from https://www.nadp.org/Dental_Benefits_Basics/Dental_BB_1.aspx