How to find the right plan to fit your budget

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It’s always a good idea to have dental insurance. Maintaining good oral health impacts your body’s overall health, so it’s important to know you can regularly access dental health services that are covered by a good insurance plan.

Like any service or product, though, there are many options to choose from in the marketplace and it can be tricky to know which dental benefits plan is best for you. A good place to start is understanding the basics of dental insurance.

Determine your dental care needs

The first consideration is to determine your needs. If you are single and younger in age, the best dental plan for you will differ from that of a married couple with several children.

Cost of the dental insurance plan you choose will be determined by the type of plan that is chosen. While premiums for dental insurance are generally lower compared to conventional health insurance, dental plans generally cover 80% of costs on basic procedures such as treating cavities, removing teeth, and root canals. More serious procedures such as crowns and treatment of gum disease may only have 50% of costs covered.

Most plans do cover 100% of preventative procedures such as teeth cleanings and X-rays.

Three Types of Dental Insurance Plans

  • Indemnity or fee-for-service plans are generally the most expensive type of coverage. They will offer the largest network of dental providers to choose from and insurers will generally put a cap on the costs they’ll cover for certain procedures. Additionally, it’s not uncommon for the patient to pay the entire cost for a procedure and then file a claim with the insurer, which will provide reimbursement upon approval of the claim.
  • Preferred provider organizations (PPO) are one of the most common types of plans available and feature a network of dentists who negotiate fees with the insurer, resulting in lower out-of-pocket fees for the patient. Patients are able to use a dentist outside of the established network of providers, but there is usually a higher cost.
  • Health maintenance organizations (HMO) are similar to PPOs in that dentists join a network of providers to provide services at reduced costs. However, in an HMO the networks are usually much smaller within a constrained geographic footprint. In some cases, there may be out-of-network services these plans will allow you to access at a reduced cost. While these are generally the cheapest dental insurance plans available, they are also the most limited.

Accessing dental insurance plans

Most people have access to dental insurance through their employer, however, insurance can also be secured through group coverage programs that might include the Affordable Care Act Marketplace or government programs such as Medicaid and the Children’s Health Insurance Program (CHIP).

The alternative to group coverage plans is purchasing an individual plan, which can be more expensive. These plans can also be more limited in the type of procedures that are covered and there’s sometimes a waiting period of anywhere between a few months to a year before major procedures will be covered.

When considering an individual dental plan, it may also be worth implementing a Health Savings Account (HSA), which can be used to set aside funds to cover costs of procedures that the plan may not cover.

Regardless of the dental insurance plan chosen, it is important to check on whether it is accepted by your dentist. If the plan is an HMO or PPO, it’s also important to determine if the dentist is within the network of those plans.

Associated Dentists is Here to Help

If you need any assistance understanding your dental insurance benefits or would like to inform us of any changes to your coverage, reach out to our in-house insurance department at our Madison and Verona locations.