It’s easy to spend hundreds, even thousands, on dental care; and plenty of people may find themselves in that position. But shopping for a dental plan can be confusing. Here’s some important information to know if you’re considering dental insurance:

#1: Dental Insurance Covers Some Services at 100% — But Not Everything

Dental insurance covers a portion of your dental care costs. You pay a monthly premium and often a deductible. In return, plans cover you for preventive care such as dental exams and cleanings, at zero cost.

Once you meet a deductible, your plan may cover restorative services, such as fillings for cavities, tooth extractions, root canals, crowns, bridges, and dentures. But it usually won’t cover 100 percent of the costs for these. You’ll probably still have coinsurance, which means you’ll be expected to pay a percentage of the dentist’s charges as well. (Dental insurance also doesn’t usually pay for cosmetic procedures like tooth whitening.)

Most dental plans also have annual maximums for each plan year. So, if your annual maximum is $2,000 and your dental expenses are $3,000, you’re responsible for the additional $1,000.

There are two main ways you can get dental insurance:

  • Through your employer.Many employers offer dental coverage as part of their employment benefits. You can apply for it during your company’s annual open enrollment.
  • Purchasing private dental insurance.If your employer doesn’t offer dental coverage, you can buy a separate, stand-alone dental plan from a private insurance company.

To find a plan that meets your needs and budget, talk to one of our HealthMarkets agents. Call (800) 642-0607.

#2: Dental Insurance Is Especially Helpful for Certain People

Dental insurance can lower the amount of money you owe out of pocket when paying for dental work. But there are certain people it may be particularly beneficial for:   

People who visit the dentist often. “Dental insurance is great for the person who goes in for regular checkups and cleanings, particularly if they have a history of periodontal disease, significant cavities, or missing teeth,” says Thomas J. McCarthy, DDS, a dentist in Brookfield, Wisconsin, and dental adviser to Sporting Smiles. In addition, he says, anyone with a medical or physical compromise that affects their ability to properly care for their teeth should consider insurance. Some plans will even cover an extra visit for this reason.

Families with children. “Dental insurance is also helpful for people with children,” says McCarthy. so if your child needs umpteen cavity fillings, you have the peace of mind of knowing that they’re covered.

There are also limits on the amount you’ll have to pay for each child out of pocket for ACA-qualified stand-alone dental plans: $350 for one child and $700 for two or more children. After you reach this amount, your dental plan must cover everything. (This does not apply to pediatric plans embedded in a health plan.) Some children may qualify for free or low-cost dental care through Medicaid and the Children’s Health Insurance Program (CHIP).

People with Original Medicare. Dental insurance is recommended for folks with Original Medicare, as dental benefits aren’t covered. Unfortunately, around half of all Medicare beneficiaries—roughly 24 million people—don’t have dental coverage, according to the Kaiser Family Foundation.

Oral care is critical to your overall health as you age. There are several dental conditions that become more common in older adults, such as periodontitis (severe gum disease). Many Medicare Advantage plans offer dental insurance, though most require you to pay 50% coinsurance and on average have an annual limit of $1,300, according to KFF.org.

#3: Premiums and Deductibles Can Vary Widely

The cost of dental insurance varies by plan, but the annual premium is usually between about $400 and $700, says McCarthy. But a low premium may not necessarily save you money if you have a high deductible or higher coinsurance, he adds. That’s why it’s important to compare different plans so you get a better sense of out-of-pocket costs.

Another option is a discount plan or a membership plan. Many dental offices now offer membership plans in which you pay a certain amount a month—usually between $20 and $40—for a series of services that include things like two free exams and cleanings, annual X-rays and one emergency exam, says McCarthy. You may also get a discount on more extensive procedures like fillings and extractions. These types of plans are becoming more popular: About 1 in 4 dentists now offer them, according to a 2021 survey from the American Dental Association.

Some discount plans don’t require a dental office membership. Instead, you pay a low monthly fee—as low as $10 in some cases—and receive significant discounts (hence the name) on everything from cleanings to root canals to orthodontics when you visit a participating dentist.

#4: Ask the Right Questions

The American Dental Association recommends asking an agent or plan representative the following questions about the dental plans you’re considering to help determine if it’s right for you:

  • Can you choose the dentist you want?
  • What are the plan’s total costs, including the premium, copayments, coinsurance, and deductibles?
  • What’s the plan’s annual maximum?
  • Does the plan have an out-of-pocket limit?
  • Does the plan cover pre-existing conditions?
  • Does the plan cover braces?
  • Does the plan cover emergency treatment, including emergency care away from home?

You should also find out if there’s a waiting period before a certain treatment can be covered. Learn more about what types of procedures might require a waiting period here.

Ready to start comparing dental plans? HealthMarkets can help you find a good fit.

Before you choose your plan, have a conversation with your dentist, recommends Peter Pinto, CEO of Deering Dental in Palmetto Bay, Florida. “You may find one that you think has robust benefits, but it turns out all the dentists in the area find reimbursement rates so low they don’t participate,” he explains.

Once you’ve chosen your plan, check with your plan provider to make sure any treatment or procedure is covered, Pinto recommends.   “Different plans may have different stipulations for when they’ll cover a crown, for example,” he says. “They may require a tooth to be completely hollowed out before they agree to it, or they won’t cover a crown if it’s for a dental implant.”

Remember, there’s no rule that you have to stick with your plan forever either. If you don’t like it, you can always shop around.

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References

1. American Dental Association. Dental Benefits and Medicaid. Retrieved from https://www.ada.org/en/science-research/health-policy-institute/dental-statistics/dental-benefits-and-medicaid Accessed October 29, 2021

2. HealthyMouth.org. Choosing a Dental Plan Under the Affordable Care Act. Retrieved from https://www.mouthhealthy.org/en/dental-care-concerns/aca-dental-plans Accessed October 29, 2021

3. HealthyMouth.org. What Are the Different Types of Dental Plans? Retrieved from https://www.mouthhealthy.org/en/dental-care-concerns/types-of-dental-plans Accessed October 29, 2021

4. HealthyMouth.org What to Ask When Choosing a Dental Benefit Plan. Retrieved from
https://www.mouthhealthy.org/en/dental-care-concerns/questions-to-ask-when-choosing-a-plan Accessed October 29, 2021

5. Healthcare.gov The Children’s Health Insurance Program (CHIP). Retrieved from https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/ Accessed October 29, 2021

6. American Dental Association Health Policy Institute. June 2021. Covid 19: Economic Impact on Dental Practices. Retrieved from https://surveys.ada.org/reports/RC/public/YWRhc3VydmV5cy02MGM3OTJjY2IxNTYxMDAwMGY2MDZlNjEtVVJfM3BaeGhzWm12TnNMdjB4

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