Tips for Choosing the Right Dental Insurance Plan – Forbes Advisor

Personal expenses related to paying for dental care can be extremely expensive. That’s why many Americans opt for dental insurance, often offered through their employer or directly from a dental insurance company.

Dental insurance can significantly reduce what you pay for dental services, but you want to find a dental plan that’s right for you.

What does dental insurance cover?

Dental insurance plans vary in terms of coverage, plan types, and costs. Dental insurance plans can cover preventive and diagnostic services, including exams, x-rays and basic dental cleanings. More comprehensive plans may also provide some type of coverage for extractions, fillings, crowns, root canals, dentures, and partials.

“Orthodontics, implants, and cosmetic procedures like veneers are generally not covered,” says Leila Chang, CEO of Florida Dental Benefits.

Comprehensive dental insurance plans generally provide:

• Preventative services at 100% coverage
• Basic services at 80% to 100% coverage (fillings, root canals, extractions, etc.)
• Major restorative services at 50% to 80% coverage (crowns, inlays/onlays, bridges, dentures)

What types of dental insurance plans are available?

Dental insurance plans typically have networks of providers, similar to health insurance plans.

HMO/EPO dental plans

These dental plans can offer a wide variety of benefits, including diagnostic and preventive services at little or no cost and other services provided at a fixed copayment (which is the responsibility of the member). But note that you must stay in the plan’s network.

“These plans provide services only through a panel of network participating dentists. They don’t need claim forms,” Chang says.

If you get dental care outside of the HMO/EPO provider network, you are responsible for all costs.

PPO Dental Plans

PPO dental insurance plans have a network of dentists, but dental PPOs also offer the freedom to choose an out-of-network dentist. Staying in the provider’s network costs you less, but going to an out-of-network provider is allowed at a higher cost.

“The benefits are richer if the member stays within the network,” says Chang. “These plans generally cover preventive and diagnostic services at no cost to the member.”

The dental insurance plan pays a percentage of the bill and the member is responsible for the rest of the balance. For example, if you get a root canal and the dentist charges $1,200, the plan may pay 50% of the cost and you will be responsible for the remaining $600.

Dental PPO plans usually have a deductible and may have a maximum amount they will pay out annually (often between $1,000 and $2,000). Once you reach the maximum payment, you pay the remaining costs for the rest of the year.

Dental Discount Plans

Dental discount plans are not actually dental insurance. Instead, they offer reduced flat fees for covered procedures and generally require members to visit a dentist who participates in the plan.

Cost of dental insurance

The average dental insurance policy with full coverage costs $47 per month, according to the Forbes Advisor analysis of dental insurance premiums. A preventative dental plan costs an average of $26 per month.

Several factors, including coverage and out-of-pocket, influence how much you pay for dental insurance. Here are examples of monthly dental insurance costs.

Examples of Dental Insurance Costs by Plan

Tips for Finding the Right Dental Insurance Plan

If you’re looking for dental insurance, it’s wise to do your due diligence, compare different insurers and plans, and compare the costs and benefits. Here are some tips for finding the dental insurance plan that’s right for you.

Tip #1: Check if your employer offers dental benefits

The most comprehensive dental coverage at the best price is offered by employer group plans. If you are looking for dental insurance, your first stop should be your employer, if provided.

Tip #2: Determine which type of dental plan best suits your needs

Determine whether you prefer the lower costs of an HMO or the freedom of a PPO. Dental HMOs can provide good coverage, but you must stay within the plan’s provider network. A dental PPO offers more flexibility, but it comes at a cost.

Also consider whether you need preventative coverage or want a more comprehensive plan. The choice will influence the cost.

“While most dental plans include two checkups and cleanings per year, comprehensive policies can offer better protection, including coverage for fillings, crowns, extractions, root canals, deep cleaning, guards overnight, access to virtual care 24/7 and more,” says Colleen Van. Ham, CEO of UnitedHealthcare Dental.

Tip #3: Understand Network Access and Reimbursable Fees

Dental plans, like medical plans, usually have in-network providers. Check the extent of the network of providers in your area in case you need to change dentists or find a specialist.

“Opting for an in-network dentist can help avoid financial surprises and unnecessary outlays,” says Van Ham.

Tip #4: Get dental insurance before you need treatment

Don’t wait for your teeth to become a problem. Dental insurance plans may require a waiting period, which is a specified period of time after you purchase the plan that you must wait before you are eligible for treatment benefits.

For example, a dental plan may require waiting at least six months before receiving restorative services such as a filling or 12 months before paying for a denture or crown.

Dental insurance plans generally do not require a waiting period for preventive care.

Tip #5: Make sure your provider takes dental insurance

Dental insurance policies have provider networks that can affect where you get care and how much you pay for care.

Make sure your dentist accepts this specific dental insurance plan. Ask directly at the dentist’s office, as insurance companies may not have the most up-to-date provider network information on their websites.

If the dentist does not accept the plan, you will probably have to pay more or all of the treatment costs if you continue to go to that dentist.

Tip #6: Understand the limits of dental insurance

Unlike health insurance plans, there may come a time when a dental insurance company stops paying for your care. This when you have reached the plan’s annual maximum. A plane can also have a maximum life for certain services, such as orthodontics.

There are a wide variety of plan caps. For example, one plan may have an annual maximum of $1,500, while another may have a sliding scale of $1,000 for the first year and then higher annual maximums in subsequent years.

Dig into this information before deciding on a dental insurance plan.

Is dental insurance worth it?

Dental insurance can be a valuable investment, especially if you want to maintain your oral health and avoid dental pain and disease.

If you expect to only need regular dental cleanings and checkups, dental insurance may not be worth it. But if you’ve been lax on regular cleanings or are worried about a large bill for major dental work, dental insurance is a financial safety net.

“A dental exam can detect symptoms of more than 125 diseases and medical conditions, including leukemia, diabetes and eating disorders. Poor oral health can lead to further complications in people with heart disease and diabetes. Regular visits to the dental office can also avoid costly procedures like root canals and extractions,” says Chang.