Dental insurance helps pay for treatments like cleanings, fluoride applications, fillings, and oral surgery that improve the overall health of teeth and gums. In some cases, people with dental insurance may have to wait a period before their insurance company pays a portion of the costs. Since dental insurance coverage is not standardized, each plan differs from the next. For example, one plan may not cover braces or Invisalign while another will cover orthodontic treatments. Take the time to research different insurance plans before purchasing one to ensure you are paying for dental coverage you need and will use.
Most dental insurance plans cover the following procedures:
Dental insurance provided by employers generally does not pay for cosmetic dentistry (veneers, teeth whitening) or orthodontia to correct crooked teeth. However, employer dental insurance may pay for braces if the dentist submits a report stating the procedure is necessary to restore and maintain oral health.
Employer health insurance plans often include optional dental insurance. If an employee chooses to opt into dental insurance coverage, their monthly premiums will increase depending on the type of coverage they want. If an employer does not offer dental insurance, you can purchase individual coverage from a health insurance agency that provides stand-alone plans. Be aware some dentists may not accept certain dental insurance plans. If you plan on visiting a particular dentist all the time, check with the clinic staff to find out which plans they do accept. Medicaid and Medicare also help pay for dental costs. If your income is under $40,000 annually, call your state's health department to learn more about Medicaid and Medicare eligibility. In some states, Medicaid also provides partial denture coverage for pregnant women and people with certain types of cancer.
All dental insurance plans have limits to how many times you can have your teeth cleaned per year and what kind of dental procedure is covered. Procedures not covered by a plan are called "exclusions." To learn which exclusions would impact how much you pay for a dental procedure, review the policy booklet provided by dental insurance companies. In most cases, both employer and stand-alone dental insurance policies will not pay for braces to straighten minimally crooked teeth nor will they pay to whiten stained teeth. Dental insurance plans rarely cover treatments not needed to prevent further damage to teeth or gums.
Direct reimbursement dental insurance plans pay the covered individual a predetermined amount (usually a percentage of the cost) of the total amount they spend on dental treatments, regardless of what kind of dental procedure they need. Direct reimbursement plans usually allow people to choose the dentist they wish to see while providing incentives to work toward a more economically sound solution to oral health issues.
UCR dental insurance programs are "Usual, Customary, and Reasonable" plans that allow you to see dentists of your choice. UCR policies either pay a percentage of a dentist's fee or pay a plan administrator's customary or reasonable fee limit, depending on which costs less. Limits are set by the contract between a third-party payer and the plan purchaser. With UCR dental insurance programs, there is typically a significant fluctuation and lack of standard regulations on what the plan determines to be a customary fee percentage.
Dental insurance comes in indemnity, PPO, and HMO plans. Health maintenance organization (HMO) plans restrict coverage to dentists in a limited network of providers. Preferred provider organization (PPO) are more popular than HMO. They let people visit dentists outside a network of providers. However, those covered by HMO plan can opt to see in-network dentists for reduced rates. Indemnity dental plans allow patients to visit any dentist they wish. This plan generally covers a certain percentage of the cost of dental procedures. For example, if you get a dental crown costing $600 (out of pocket expense) under an indemnity plan, you may pay only $500 under a preferred provider organization plan.
Dental insurance deductibles are the shares of cost patients pay for dental procedures before insurance plans kick in and cover the rest of the cost. If you have a $200 deductible after purchasing a dental insurance plan, you will need to pay $200 before that plan starts helping pay for dental treatment costs. Deductibles are charged on either a one-time base or annually. Some dental plans may not have deductibles. If a dental insurance plan has a family deductible, this means it applies to the costs of all family members included in the plan. A family dental plan with a $200 deductible means $200 in total (across all members in the plan) must be paid, and then the coverage will begin.
Most dental insurance plans pay a percentage of denture costs if the dentures are medically necessary. In general, the insurance will cover between 15 and 50 percent of the total cost, including examinations, impressions, and dental work needed before being fitted for dentures. Medicaid will cover nearly all or all the costs associated with full or partial dentures. Medicare offers different levels of insurance to help senior citizens pay for new or replacement dentures.
One alternative to a traditional dental insurance plan is the discount dental plan from individual dentists. They have patients pay a yearly fee to access certain dental treatments at a discount or set rate. Discount dental plans typically cover preventive services such as bi-annual exams, cleanings, and x-rays. Also, dentists offering discount plans may include teeth-whitening treatments or other cosmetic procedures in their plans. People opting for discount dental plans do not have to wait for their insurance agency to pay for procedures, nor do they have a deductible to worry about. However, your choice of dentists will be limited when seeking one with a discount plan, as most dentists only take traditional dental insurance.
Depending on how healthy your teeth and gums are, paying for insurance may be more expensive than just paying for yearly exams, cleanings, and an occasional filling. While families with children who need regular dental care should always have dental insurance, single adults who do not have ongoing issues with oral health may consider foregoing insurance until they begin having problems that require more extensive treatment.