Looking for Dental Insurance?
We offer a variety of plans to fit your individual and group needs
Types of Dental Insurance Coverage Plans
Before considering a dental insurance company, customers should see what type of coverage is included in the dental insurance plan they choose. Some dental insurance providers may be more focused on businesses and specific organizations, while others may cater to individuals and families.
- Individual/Family dental coverage: The vast majority of dental insurance firms provide coverage for individuals and families.
- Group (employee) dental coverage: Some dental insurance companies prefer to cover small groups (employers) starting from two to 100+ people. Other dental insurance companies prefer to cover large groups with tens of thousands of employees.
- Seniors: Medicare Part A for hospital coverage and Medicare Part B for medical coverage don’t include routine dental coverage so retirees within six months of turning 65 should think about a private health insurance policy with dental coverage.
- Federal employees: Some dental insurers specialize in offering benefits to U.S. government employees.
- Americans working or traveling abroad: Some dental plans are designed specifically to cover private or public sector workers abroad.
Types of Dental Insurance Plans
Also known as indemnity or fee-for-service plans, traditional dental insurance involves the patient paying a percentage of the total cost and the insurance company paying the rest. These plans usually have a co-payment, deductible, and maximum out-of-pocket cost. You may have to pay for services up front, file your own claims and wait for the insurance carrier to reimburse you, but this type of plan offers the largest choice of dentists. Indemnity plans are usually pricier than other plans.
Dental Plan Organization/Preferred Provider Organization (PPO) plans utilize an in-network list of dentists to provide services to patients at a negotiated reduced rate, and patients pay a percentage of that reduced rate. Each plan usually requires first meeting a deductible. These plans come with an annual maximum benefit.
Dental Health Maintenance Organization (DHMO) plans also utilize an in-network list of dentists to offer services to patients at a negotiated discounted price. Generally, patients only see one dentist for oral health needs and can be referred for specialty care. With a DHMO plan, there may or may not be an annual maximum benefit limit and deductibles are not a part of the plan. Instead, fixed dollar amounts or copayments are paid for treatment. These plans can be very affordable for those looking for basic services; however, there may be limitations for major procedures. If you visit an out-of-network dentist, you may be responsible for the entire bill.
Supplemental dental coverage is a separate dental plan that covers procedures not covered by a basic dental plan.
Non-insured discount plans
Discount plans are not actually insurance. These plans simply offer a discount off the sticker cost for dental care, and there is little or no paperwork, annual limits or deductibles so long as patients visit a participating dentist. This option is best for those who do not require or want consistent oral health care.
Dental Insurance Benefits and Services
In general, every plan covers preventive care and basic procedures, but some consumers may unknowingly sign up for a dental insurance plan that does not cover an operation they may need. It is crucial to check benefits and services offered before choosing the best dental insurance plan for your needs.
- Preventive care/exams: The provider usually offers solid coverage for preventive care services such as routine oral examinations, periodontal examinations, X-rays, general cleanings, topical fluoride treatment, and sealants.
- Basic procedures: Basic procedures, such as emergency care, extractions, fillings, space maintainers, minor oral surgery, and crowns, are sometimes covered. For good coverage of basic procedures, consumers may need to pay more.
- Major procedures: Generally, only top-of-the-line coverage handles major services. Common major procedures that are covered by more comprehensive dental insurance plans include crowns, bridgework, dentures, periodontal cleanings, gum therapies and root canals.
Dental Insurance Cost
Even with insurance, dental care is expensive. Consumers should analyze their dental claim histories to forecast how much they will pay over the entire year. In addition to a monthly premium payment, there is usually a co-payment at each visit and a coinsurance responsibility.
- Deductible: This is a specific dollar amount customers have to pay out-of-pocket before the insurance company begins making payments for any claims. It is not part of the copayment.
- Copayment: This is a fixed amount paid at the time of the dentist’s visit. It is a separate charge and not applied toward your deductible, which you need to reach before insurance kicks in.
- Coinsurance: Given as a percentage, coinsurance is what the client has to pay after satisfying the co-payment and/or deductible for the plan. This can vary for different services.
- Maximum out-of-pocket cost: Maximum out-of-pocket cost represents the total amount policyholders will have to pay for dental care throughout the year.
Each insurer partners with various dentists throughout certain states and regions. Dentists perform services according to a rate schedule, which is a set fee agreed on by the provider and insurer. People usually pay less when the visit a dentist in an insurer’s network. Customers switching insurers may want to double check if their dentist is in the new insurer’s network. Conversely, if switching dentist, customers should check to see if the new dentist belongs to the patient’s insurer’s network.
- In-network list: Before purchasing a plan, customers should look over the list of in-network dentists and make sure there is an in-network professional in their area.
- Financial incentives: Under certain plans, patients save lots of money by going to in-network dentists. Other plans may even refuse to cover care from out-of-network dentists.
- Flexibility: To satisfy customer needs, some dentists and plans are willing to make exceptions for patients when it comes to network coverage.
Limitations and Exclusions
From gold crowns to failure to keep an appointment, dental insurance companies always write in a list of exclusions, and consumers are responsible for reading and understanding their insurer’s list.
- Cosmetic dentistry: Teeth whitening, bonding, enamel shaping and contouring, implants and orthodontics are some examples of cosmetic services that are typically not covered by plans.
- Annual maximum benefit: The maximum benefit refers to the highest dollar amount the dental insurance firm will pay per family member per year. It is usually a part of PPO plans. This is a very important consideration as the cost of major oral surgery, once the maximum annual benefit exceeded, could fall mainly the patient’s responsibility with such a plan.
- Specialties: Basic dental plans typically exclude orthodontics, endodontics, periodontics and prosthodontics.
- Discounted rates: Discounts passed along by in-network dentists may not be available in some states.
- Standalone Dental: Depending on the state in which you live, some insurers will not let you buy dental coverage unless you are also covered by one of the insurer’s medical plans.
- Special circumstances: Dental insurance companies even exclude services that may be needed due to special circumstances, among which may include losses from armed conflict, self-inflicted injuries, and infections.
- Waiting periods: Some basic dental services may incur a six-month waiting period and some major services may incur a 12-month waiting period.
A great way to save money on dental insurance is to combine it with other types of health insurance. Customers can check bundle offers when they sign up for a plan.
- Vision: Dental insurance and vision insurance can often be purchased together at a discount.
- Accident: Many dental insurance companies offer an accident and dental insurance package, which helps cover injuries not covered by traditional health and dental insurance.
- General health insurance: Many health insurance plans let consumers add dental insurance at a discount.
We can help you navigate and choose the best dental insurance plan that fits your needs.
Most dental plans have benefits that allow members to visit the dentist every 6 months. Though some major treatments require multiple visits after the regular exam which is allowed by most plans.
Dental insurance is different than health insurance. Dental insurance plans typically have annual benefit maximums ranging from $1000-$3000 per member per year. Health insurance plans usually have unlimited maximums though with a much higher monthly cost. In a way, dental plans are designed to help offset the cost of care, while medical plans generally cover a greater portion of costs.
Some dental plans will have coverage for dental implants, but many individual plans do not offer benefits for implants. So it’s important to check plan details to make sure coverage is offered if you need implants. Renaissance Dental plans do offer coverage for dental implants.
It is common for some individual dental plans to have waiting periods for major services. However, there are certain plans and carriers that offer plan options with no waiting periods. Some plans with Delta Dental and Renaissance Dental offer no waiting periods for major services like crowns and root canals.
Some DHMO plans or discount dental plans require members to use an In-Network dentist in order to receive plan benefits. But PPO dental plans and Indemnity plans allow members to also see Out of Network dentists.
PPO dental plans are probably the most common type of dental plan because they give flexibility to members to see any dentist, while also offering the advantage of seeing In-Network dentists for greater benefits. PPO dental plans are also usually considered full coverage dental plans because they typically have benefits for routine services and exams, as well as major services like crowns and extractions.
There are many types of dental plans but a few common categories. Dental insurance plans typically consist of PPO dental plans, DHMO plans, and Indemnity dental plans. PPO plans have provider networks but generally allow members to see any dentist. DHMO plans are usually In-Network only, while Indemnity plans do not have a network and pay the same at any dental office. There are also discount dental plans that are not insurance but they give members discounts on services at In-Network dentists.
Yes. Most dentists will allow members to pay for services on a cash basis. While basic exams can be manageable to pay out of pocket, many major treatments like root canals, crowns, or bridges can run into thousands of dollars and can be difficult to pay for without other assistance.
This is a great question. Dental insurance can benefit most people who plan to take
care of their teeth by regularly seeing a dentist. Dental plans allow you to see a dentist
routinely for check-ups and also help pay for major treatments like root canals or
crowns which can be expensive. Dental plans also have the advantage of
offering provider networks, procedure discounts, and other helpful features.