Whether shopping for dental coverage through an employer or the individual Marketplace, paying attention to details like deductibles and annual limits is essential. Other factors include how a plan treats basic versus primary care and whether it offers a PPO network or a discount plan. Generally, dental plans offer several advantages over traditional fee-for-service insurance.
Coverage for Preventive Care
The cost savings of dental individual insurance plans coverage can make it much easier to keep up with routine visits, which are vital for maintaining good oral health and catching problems early when they are most treatable. Many people skip necessary care without insurance and may require more costly procedures later in life. When selecting a plan, it is essential to consider the monthly premium and deductible. A deductible is the amount you must pay toward your treatment before the insurance company starts paying. In addition, some dental plans have annual or plan-year maximums for specific procedures, which may leave you paying out of pocket if you need additional care. Other factors to consider include whether the plan is an indemnity or PPO and what types of dental equipment and services are covered. A PPO is similar to a health insurance plan and provides a network of dentists who will accept a lower co-pay for services. This type of dental insurance may have a yearly deductible, often waived for preventive and primary services.
Coverage for Emergencies
An unexpected dental emergency, like a dislodged tooth or gum disease, can be stressful. Fortunately, both the Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO) plan to cover some of the costs of emergency treatment. Both employer-provided and stand-alone plans usually offer 100 percent coverage for preventive care, such as routine checkups and X-rays, and 80 percent of essential services, including fillings and simple extractions. However, if you need extensive work done, such as crowns or dentures, the percentage of coverage may drop significantly. When researching different dental insurance plans, consider the details surrounding deductibles. You also want to ensure your dentist is in the provider network of any plan you are considering, as this can considerably reduce your out-of-pocket expenses. Many dentists also partner with third-party financing organizations to help patients get the care they need on a monthly payment schedule that fits their budget. In addition, some dentists accept credit cards, which can help consumers manage their finances and prevent unnecessary debt accumulation.
Coverage for Major Restorative Care
Some dental plans cover major restorative work, such as tooth fillings and crowns. These treatments help to prevent future complications, such as infection and bite problems. Often, these procedures require a deductible and annual limit before the insurance company will cover them. To determine which plan is best for you, consider the costs and benefits of each one. If you need to decide quickly, consider an individual plan from an insurance provider that offers a wide range of options and is available online or over the phone. Purchasing an individual plan can also be more convenient if you already have a preferred dentist.
Coverage for Cosmetic Procedures
Some dental plans offer coverage for cosmetic procedures like whitening and orthodontics, though this is rare. These types of plans typically have higher premiums. When comparing dental insurance options in the Marketplace, consider monthly costs, copayments, and annual maximums. You will also want to consider whether the plan offers a choice of dentists, as some plans require that you visit a network of providers (typically HMOs and PPOs), while others allow you to choose any licensed dentist. Some dental insurance policies also provide additional benefits beyond primary care, such as coverage for a more comprehensive selection of dentists or more expensive treatments like dental implants or root canals. These are often called supplemental dental plans and can significantly reduce out-of-pocket costs for individuals seeking these more costly treatments. These supplemental plans are usually offered through employer groups or sold separately from the health plan. Individuals can also find a wide range of these options by searching the Marketplace.
Coverage for Dental Implants
Dental implants are increasingly common, and some insurance plans cover some or all of the cost for these advanced tooth replacements. However, reviewing your specific policy and understanding how this type of coverage works before you get any work done is essential. Many dental insurance products feature annual coverage maximums. This is particularly true of DHMOs, which offer low-cost premiums in exchange for requiring you to stay with a network of contracted dentists and to pay a flat coinsurance fee for each service. Many of these types of products also have a one-time deductible and roll over some portion of unused annual maximums.