woman with dental insurance policy

If you are young, healthy and have had relatively good oral health as a child or teenager, it may be tempting to simply skip out on dental insurance. Besides, it’s likely that you could spend no more money out-of-pocket for a couple of check-ups and cleanings each year than you would for the annual cost of an average dental policy.

Perhaps. But most of us need far more dental work than we care to admit. And, though you may be young and healthy now, as time goes on the likelihood of needing something more extensive than a cleaning increases, as well.

What Dental Insurance Coverage Looks Like

A typical dental insurance policy plan provides what is known as 100/80/50 coverage. This can be categorized into the following major types of care:

  • Preventive care, which includes exams, cleanings, and X-rays received during bi-annual dental checkups. These are usually covered 100 percent.
  • Basic dental procedures such as fillings, extractions, and periodontal work are typically covered up 80 percent.
  • Major procedures often include crowns, root canals, dentures, bridges, or implants are covered for 50 percent, and sometimes less.

According to one article,

“There are variations in individual plans. For example, a root canal could be considered either a basic or a major procedure. Most plans allow you to purchase separate coverage for orthodontic care if it isn’t covered. Fewer plans will cover cosmetic care (like teeth whitening). This is usually an out-of-pocket expense.”

The most common dental plans are those you might have available from your employer, which are typically group plans. These types of plans can also be purchased individually. Group plans usually fall into two types, PPO and HMO plans. In addition, most dental plans must remain in effect for at least one year.

The type of plan you choose is dependent largely on your needs today and what you anticipate your dental care needs to be in the near future.

An article at Investopedia.com notes that

“Indemnity insurance plans allow you to use the dentist of your choice, but the common PPO and HMO plans limit you to dentists in their networks. If you have a dentist you like, ask which insurance and discount plans he or she accepts. If you’re OK with using a new dentist, a PPO or HMO might fit your needs.”

What You Should Know About Dental Insurance Policies

Preventative Care is Typically Covered

For many people, especially those under 30 and in good general health, having annual, or six-month checkups, fully covered is the biggest and most immediate benefit. If you opted to pay for these visits yourself, it would be costly, but most dental insurance plans cover 100% of the cost.

Coverage for Basic Restorative Care

Generally speaking, typical dental plans will cover 80% of the cost of fillings, extractions, and periodontal work, while you’ll only be responsible for the remaining 20%. This means that a $500 visit may only cost you $100. It can be a bit more if you prefer composite (tooth-colored) fillings, for example, since most dental plans will only cover amalgam (silver) fillings.

Major Restorative Services Coverage

Crowns, bridges, implants, and root canals are typically covered at a rate of 50%, which is beneficial for you since a typical root canal with a crown can cost upwards of $2,000. Although it may seem like you’re still paying a lot, it’s not statistically likely you’ll need these services often.

Most Corrective Services Are Not Covered

With orthodontia being far more common for adults now, this can be important to you. If you need braces or other orthodontia, you may need to purchase a rider for a few dollars more per month. These policies typically cover 50% of the cost of a corrective service.

Waiting Periods for Dental Work

Typically, preventative care visits are covered immediately, or within 30 days. Depending on your plan, any basic restorative services must wait until after 3 months or more, and major restorative services cannot be provided for the first 6 months. Note, too, that some policies only cover a few services each calendar year.

Keeping Your Current Dentist

With most plans you may need to find a new dentist unless yours accepts your new insurance plan. If not, find out how your plan covers benefits for going “out-of-network”. If you don’t already have a dentist, then it is simply a matter of reviewing your plans network of providers and deciding on one.

The High Cost of Being “Cheap”

Your dental care needs are different than other people’s and it makes no sense to spend more for a policy than you need to. However, while you don’t want to pay for benefits you don’t need, choosing the cheapest plan is not always the wisest option.

A low-cost policy may provide you with an extremely “affordable” plan but leave you without important benefits that you may not realize are absent until you need them. Because the details and benefits of dental plans can vary greatly, it’s important to review your options with a professional insurance agent or broker to ensure that your policy decision doesn’t leave you coming up short.

It’s critical to review and compare policy plan features such as annual maximums, waiting periods, procedures that are excluded, extent of the provider network, and options for choosing or using an out-of-network dentist, if needed.

It is tempting to spend as little as possible on a dental insurance policy – or to forego coverage altogether – but the benefits of coverage can easily become evident if you have a dental emergency or even an unexpected cavity or two.

And, one of the additional benefits of purchasing a dental insurance policy is the likelihood of increased oral health. It’s been shown that adults and children with dental benefits are more likely to go to the dentist, receive restorative care and experience greater overall health, according to a report by the National Association of Dental Plans.