With the increasing demand of having the perfect smile, dental treatments are being upgraded with technology to suit the needs of the patients. Along with it, the cost of dental treatment is shooting high up. The harsh reality of today is that people do not have enough money in the budget to cover the necessary cost of dental treatments.
Although preventive dental therapies often reduce the need for advanced dental procedures, but nowadays, getting a routine dental examination and x-ray has become difficult without dental insurance. Dental insurance is a topic that drives many people crazy. While selecting dental insurance, it is essential to understand the policy, its terms, and coverage of dental emergencies.
Dental health insurance plan varies widely. Most commonly, they are divided into two policies, namely employer group policy, and individual insurance plan. Some dental insurance plans encourage a predetermination of treatment cost by the dentist before receiving the treatment. Luckily, dental insurance is inevitably an easy and less expensive option to get affordable dental treatment.
Let’s dig in further into the article, to get a better understanding of the different types of dental insurances.
What is dental insurance?
Dental insurance is a form of health insurance plan which is designed to pay a portion of the cost specific to dental treatments. The purpose of dental insurance is to absorb the risk of emergency dental treatments and cover the costs to make it affordable for the patient. (1)
Dental insurance can be of different types based on the number of people being included. For example, an individual dental insurance plan, family or group dental insurance plan.
What does dental insurance cover?
Usually, dental insurance covers the necessary costs of preventive care, tooth fillings, crown placement, root canal treatments, tooth extractions, and oral surgery. Additionally, the cost of orthodontic, periodontal and prosthodontic procedures may also be covered for two preventive visits each year. (2)
Most of the dental insurance plans follow the 100-80-50 coverage plan. This means that the insurance plan will cover –
- 100% of the preventive dental care procedures, which may include annual dental check-ups, x-rays mainly bitewings and routine dental cleanings. However, sealants may not be covered in the preventative treatments.
- 80% of the necessary uncomplicated dental procedures like tooth fillings, simple extractions, and deep cleanings.
- 50% of the major surgical procedures like root canal treatments, crown or bridge placement, and denture fabrications.
How does dental insurance work?
The main intention of the dental insurance plan is to reduce the cost of dental care for the patient. The insurance plan negotiates lower fees among the group of dentists in the area and pays a percentage of the reduced prices annually.
This is the annual capital coverage for the patient. The patient pays all expenses beyond this. For example, many participating provider network plans (PPO) set an annual maximum of less than $1500. The insurance will cover all expenses within this limit. (3)
- Suggested read: How to Treat Gum Disease Without Dental Insurance?
What are the types of dental insurance plans?
Dental insurance plans can be broadly divided into two categories –
Employer insurance plan
Often employers working in a corporate company are entitled to health insurance benefits. Dental health insurance, in this case, is separated from medical coverage at a lower cost. Most of the companies offer dental insurance to part-time employees as well. (4)
The functionality of the dental insurance provided by the employer depends on the eligibility of the employee. Often some of the dental insurance plans may have a waiting period of one year until they come into action.
Individual insurance plan
Individual dental insurance policies are expensive as compared to employer insurance plans. The individual bears the entire cost of the insurance policy. However, they are any day better than paying the initial fee of dental treatment every year. (5)
On average, an individual dental insurance plan may cost around $350 per year. For family coverage, the cost may shoot up to $550 annually. Individual or group dental insurance plans may be further subcategorized as follows –
- Dental health maintenance organization (DHMO)– this type of insurance costs the least out of all the programs. The individual is entitled to see a dentist within the network only and may require a referral to visit a specialist. The benefit of selecting this plan is that there are no annual maximum and no waiting period.
- Dental participating provider network(DPPO) – PPO is the most common and widely accepted dental insurance plan. In this plan, the individual is flexible to visit the dentists within the network or outside the network. Additionally, a visit a specialist does not require any referrals. The annual limit for this plan is around $1000 – $1500. Co-insurance payment may be available on discounted fees for care. However, there may be a waiting period for necessary and major dental procedures.
- Dental Indemnity Insurance Plan – this is traditional and the most expensive type of dental insurance. The individual has the freedom to visit any dentist or dental specialist of his choice. He can pay the dental bill in full or reimburse a set amount. The annual maximum for this plan is around $2500 and above. Co-insurance payments are based on the total rate for dental care. Additionally, basic and primary dental care treatments may have a waiting period.
FAQs for dental insurance
Does dental insurance cover braces?
Typically dental insurance covers the cost of orthodontic treatment for children; for example, if braces are required to treat malocclusions of a child, te dental insurance may cover the cost of the procedure. For adults, dental insurance may include the full or partial cost of the orthodontic treatment. You might have to co-pay 10-20% of the total amount to avail of the benefits of partial orthodontic coverage.
You can contact your insurance provider to know more details about the orthodontic coverage for you and your child.
Dental plans that cover braces
- Employer-sponsored dental insurance – this is a pet of the employer’s health care package, which usually provides orthodontic coverage. However, not all employer-sponsored dental insurance provides orthodontic coverage for adults and children. Some may limit it to children under the age of 18 years.
You can check with your human resources department to check the type of dental procedures covered by dental insurance.
- Individual dental insurance – just like employer-sponsored dental insurance, not all individual insurance provides full orthodontic coverage. With some individual dental insurance plan, you may have to co-pay a certain amount or pay an annual premium to take advantage of the insurance benefits.
- Discount plans – some dental offices allow affordable discount plans to cut down the cost of orthodontic treatment. They are also a good option for those who have reached the maximum payout limit of their dental insurance.
It is best always to offer. Moreover, you must also check your dental insurance policy to know the limitations of orthodontic coverage.
Take away message
Dental insurance is an essential part of oral health care services. It has become next to impossible to pay the cost of each dental treatment from our pocket. In such cases, dental insurance comes in handy to bear the annual cost of routine dental visits, necessary dental procedures, and emergency dental health service.
Dental insurance plans can be categorized into two types, namely an employer insurance plan and individual or group dental health insurance plan. Employer insurance plan often is the best and cheapest option for employees. The company offers annual dental health care coverage benefits for the employee, especially in cases of emergency dental treatments.
Individual or group dental insurance plan varies according to the affordability and needs of the person. This type of insurance is a little expensive as compared to the employer insurance plan.
Whatever the plan you may choose, it is essential to look at the annual maximum of the plan, the flexibility to visit dentists and dental specialists and to check the treatments covered under the policy including emergency and surgical, dental procedures. Now that you’ve gained knowledge about the types of dental insurance plans, select the best policy and take advantage of the benefits.