Dental Insurance

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The Inside Scoop of Typical Dental Plan Options

We buy insurance to protect our health. Generally, individual health plans don’t provide dental coverage or, if they do, it’s at an extra charge. Yet oral health is a very important part of your physical well-being. According to the Academy of General Dentistry, 90 percent of systemic diseases, including heart disease, have oral symptoms and there is a link between poor oral hygiene and heart disease.

Purchasing dental insurance coverage is a good way to ensure annual or bi-annual visits to your dentist, where they can prevent, detect and treat serious illness. With so many dental plans available today, how do you choose one that offers the right level of protection?

Look for a plan that offers access to a network of dentists

There are three basic types of dental insurance plans: DHMO (dental HMO), PPO (preferred provider organization), and indemnity.

DHMO and PPO plans contract with a network of dentists who agree to charge you a negotiated fee for their services, which saves you money when it’s time to pay the bill. With a DHMO, you select a primary dentist who provides preventive and basic services. If you need major or endodontic services, your primary dentist must refer you to a specialist. A PPO dental plan is similar to a DHMO, in that you must stay within a network of providers to receive coverage, but you have the freedom to visit any dentist within the network without a referral.

An indemnity dental plan offers the ultimate freedom of choice to see any dentists or specialist, but in exchange for that freedom, you typically pay more for covered services when it’s time to pay the bill. Insurance companies agree to pay a “maximum allowable charge” for covered services. In most cases this amount is enough to cover the bill, but if your dentist charges more than what the dental plan pays, you must pay the difference in addition to your portion of the bill. Indemnity plans are most often chosen in communities that do not have a strong presence of dental provider networks.

Whether you elect a network plan or an indemnity plan will largely depend on the availability of dentists in your area. Network plans offer better savings and Indemnity plans offer more freedom to choose your providers.

A good dental plan provides preventive and diagnostic benefits

Dr. Charles H. Mayo once said, “If a person can take care of their teeth and gums, they can extend their life by at least 10 years.” Brushing, flossing and visiting your dentist for preventive care visits are just a few ways to maintain good oral health.

Most dental plans will cover one or two exams and cleanings (prophylaxis) per year. In addition to cleanings, look for a plan that provides coverage for X-rays (diagnostic care), which are useful in detecting decay, gum disease, abscesses and infections.

Determine how much coverage you need

The annual maximum is the total payout a dental insurance plan will pay for services for a member during a calendar year. Determine what dental services you anticipate having for the year. Make sure the annual maximum amount of coverage is enough to cover preventive care and the unknown. The higher the annual maximum is, the higher your premium will be for that coverage.

Basic and major coverage will help pay for the big stuff

Dental insurance can help pay for filings, crowns, root canals and treating periodontal disease. These “big-ticket” items are known as basic, major and endodontic care, and they can cost from $100 to thousands of dollars. Look for a plan that will pay for a percentage of the cost (also known as coinsurance).

Good oral health is important not only to prevent oral disease but also to maintain good general health - read more here. Buying a health insurance plan is a good way to ensure you have access routine exams and affordable dental care. Look for a plan with a network of dentists; identify the how much coverage you and your family members need each year; and make sure the plan provides at least preventive and basic services.

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