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Dental insurance 101: everything you need to know

You’ve heard it all before — brush your teeth every morning and night, floss regularly, and cut back on sugar. But there’s so much more to dental care than your daily routine 

Oral health can be a good indicator of your overall health, and regular visits to the dentist can detect more than just the beginnings of a cavity — it can actually uncover up to 120 signs and symptoms of non-dental diseases, like diabetes and heart disease1, and even lower your blood sugar levels.  

 

However, even a simple cleaning can run you a pretty penny — which is why nearly 56% of Americans skip their routine visits, according to the American Dental Association

 

Cue dental insurance, a low-cost option similar to your regular health insurance plan that can help you pay for dental costs.  

 

What exactly does a dental plan cover? How does it work? We’re answering all your questions below. 

 

What does dental insurance cover?  

 

Dental insurance pays a portion of the cost of preventative services like cleanings, minor dental care like fillings and extractions, and major care like crowns and dentures.  

Most plans follow a 100-80-50 coverage structure. This means that for preventative services, your insurance will cover 100% of the cost, then 80% of minor dental care costs, and 50% for major dental care. Here’s a breakdown of what you can expect to get coverage for with a dental plan:  

 

100% covered 

Exams, cleanings twice per year, bitewing x-rays, fluoride treatments to age 14, and brush biopsy 

80% covered 

Emergency palliative treatment, radiographs/diagnostic imaging, periodontal cleaning, and other minor restorative services 

50% covered 

Denture and bridge repairs and relines, extractions and dental surgery, root canals, periodontic services, prosthodontic services, crown and cast restorations, and other major services 

 

How much does dental insurance cost?  

The cost of dental insurance can vary, depending on where you live, the kind of plan you need (i.e. an individual or family plan), and your level of coverage. You’ll pay a monthly premium, which is the monthly fixed cost for your insurance policy, similar to your health insurance plan. If your employer offers dental insurance as a benefit, these monthly costs might be slightly lower, and might be deducted from your paycheck automatically.  

 

Unlike other supplemental plans such as vision insurance, dental insurance usually has an annual deductible, or the amount of money you will have to pay out-of-pocket for your dental services before your insurance company gets the bill.  

 

Most dental plans also come with a maximum annual benefit or coverage limit, which can land somewhere between $1,000 and $2,000. This amount is what your insurance company will pay per year for your dental treatment. When you reach this amount, you are responsible for any costs the rest of the calendar year. When searching for plans, it’s important to be on the lookout for your limit, especially if you have ongoing dental issues.  

 

What are the different kinds of dental insurance plans?  

Here’s a breakdown of the most common types:  

 

Dental PPO: Dental PPOs, or Preferred Provider Organizations, are the most popular. These plans will usually have an annual deductible and coinsurance, and once you meet your deductible, your dental plan will kick in (and start sharing the costs as part of the coinsurance) until you reach your annual maximum benefit for the year. If you choose an in-network dentist, you can expect to have your preventative care services 100% covered. Depending on your plan, you may be required to pay a co-pay. If you choose to visit a dentist out-of-network with this kind of plan, your costs will be higher.  

 

Dental HMO: Dental HMOs, or Health Maintenance Organizations, are known to be some of the more affordable plans available. There is usually no deductible, and only set fees for non-preventative dental services. Just like a Dental PPO, your preventative care is usually 100% covered. Your monthly costs are lower for this plan because you are required to choose a primary care dentist from a list provided to you when you set up your plan. If you choose to see a dentist outside of the network, you will not be provided coverage. Costs can be kept low because HMO networks tend to be smaller and locally based, and the network of dentists will agree with the insurance company to provide services at a lower cost. Because every non-preventative service has a set fee, there is no annual maximum for covered services — though it’s important to note here that you’ll pay a little more because of your low monthly premium. However, if you consider your at-home oral care routine to be pretty detailed and don’t have any cavities, a Dental HMO might be a good option for you. 

 

For those that need specialty care, your primary care dentist that you choose will refer you to another in-network provider.  

 

Dental indemnity: Dental indemnity plans are often referred to as a “fee-for-service" plan. There is usually no network, so you can see any dentist you’d like. Like a Dental PPO, you will usually have an annual deductible that you’ll have to meet before your coinsurance benefits kick in. Under this plan, the amount you pay for services is determined as usual, customary, and reasonable — in other words, the amount that other providers in the area are charging for a similar service.  

 

Is dental insurance worth it? 

Enrolling in dental insurance can save you — and your wallet — from a surprise dental bill by covering some of the costsBut, it can also help keep you on top of your overall health and wellness, tooSince (with most plans) you pay $0 for routine cleanings twice a year, why wouldn’t you go? With a dental plan, it’s never been easier to get the proactive care you need at a price you want — and score savings of over $425 a year based on estimated costs. (Yep. You read that right.) Let’s break it down more here: 

 

 

WITHOUT INSURANCE

WITH INSURANCE3 

Routine cleanings (2x annually) 

$300+ 

$0 

1 filling 

$300+ 

$100 

1 crown 

$1,000+ 

$500 

Dental premium 

 

$472.08 annually, $39.34 monthly 

Total annual cost: 

$1,600+ 

$1,171.08 

Total annual savings: 

 

$427.92 

 

And if you have any other dental needs, the savings could be even more. That’s something to smile about!  

 

Plus, if you have a family, you know just how important brushing even the tiniest of teeth can be. Cavities are one of the most common chronic diseases of childhood in the United States — and can cause more than just discomfort and pain. Children with poor oral health miss more school and receive lower grades — but, this can be prevented. With a family dental plan, you can kickstart a proactive routine of twice-annual cleanings (at no additional cost!), on top of maintaining healthy habits at home.  

 

Is there anything dental insurance does not cover?  

Most dental plans offset the costs of your preventative, major, and minor services, but there are some services that your insurance will not cover. They vary by plan, but they might include:  

  • Cosmetic procedures (think: teeth whitening treatments or tooth shaping) 

  • Orthodontic treatments (like braces)

  • Veneers

  • Dental implants 

  • Dental care related to a medical condition 

 

When can I enroll in dental insurance?  

You can enroll in dental insurance at any point during the calendar year — so there’s no need to wait for Open Enrollment! However, some plans might require a waiting period that can range from six months to a full year before any standard work can be done. So if you’re thinking about holding out on dental insurance until that back molar starts bothering you — think again.  

 

How can I find a dental insurance plan that’s right for me?   

First, take some time to think about the dental care you have previously needed and what you can expect to need in the next year or so. Do you have any cavities? How rigorous is your at-home routine? Some other questions to consider include:  

  • How much can I afford to pay monthly in premiums?  

  • How much (if anything) will I pay for a regular cleaning? What about the minor and major services I might need in the near future 

  • What is the maximum annual limit for this insurance policy? What about the deductible?  

  • Is my current dentist considered in-network on this plan? If not, am I willing to find a dentist that is? 

     

Once you’ve established your needs and wants, start searching! You can find a dental insurance plan through Kasasa Care — it only takes a few minutes to get a free quote. In partnership with KindHealth, we’ve made it easy to pick an individual or family plan that best fits your lifestyle, without the confusing fine print or head-scratching terms.  

Enrolling in a dental plan is so much more than maintaining a pearly-white smile.

It’s actually one of the best ways to proactively stay on top of your overall health and wellness — and keep costs down, too. Because, let’s face it — nobody smiles at a surprise dental bill.  

  

 

 

1Little, James W., Falace, Donald A., Miller, Craig S., & Rhodus, Nelson L. (2013). Dental Management of the Medically Compromised Patient (8th ed.). St. Louis, MO: Mosby Elsevier. 

2Based on estimated costs for non-insured consumers: Routine cleanings (2x annually), $300+; Cavity filling, $300+ per tooth; Dental crowns, $1,000+ per tooth. 

3Price is for a 40-year old individual in ZIP code 78759 for September 1, 2020 effective date. 

 

Tags: Health, Care, Dental

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