HEALTH
Top Benefits of Individual Dental Plans You Need to Know
Dental insurance helps people save money on routine checkups and professional cleanings that can spot oral health problems before they become serious. Some individual dental plans also cover basic procedures and major restorative work.
Look for a plan with a network that provides in-network savings. Some individual dental insurance plans require that you see dentists in their network for a set copayment, while others have no network restrictions.
Coverage for Preventive Care
Individual dental plans offer a range of benefits to promote good oral health. Most cover preventive care at 100%, which is an incentive to receive routine cleanings and exam visits.
Choosing the right plan requires careful consideration of monthly premiums and out-of-pocket costs. For example, Dental Health Maintenance Organizations (HMOs) have the lowest premiums and copayments and rarely have annual maximum limits on care.
However, they may limit subscribers to a contracted list of dentists, which can limit choices and access to care. A better option is a Dental Preferred Provider Organization (DPPO) plan, which allows subscribers to choose from an extensive network of dentists. However, these plans typically have higher premiums and deductibles than DHMOs.
Coverage for Basic Procedures
A common feature of dental plans is their coverage of essential vital services, such as fillings and root canals. Generally, the majority of the costs for these procedures are covered, although some plans have deductibles.
A deductible is an amount a plan holder must pay before the insurance company begins to cover treatments. Most dental plans have a deductible, but some do not, and routine treatments such as annual or bi-annual cleanings, exams, and X-rays typically don’t count toward the deductible. Some plans also have annual and lifetime maximums on benefits.
Coverage for Major Procedures
Some dental plans have deductibles and coinsurance, similar to medical insurance. These can reduce your monthly premiums but require you to pay more out of pocket before the plan kicks in.
Most individual dental insurance plans do not have annual benefit maximums. Still, if you have one, it’s essential to understand how much the plan will cover for primary restorative services. This will help you budget for any potential expenses.
Indemnity dental plans may work best for you if you want the flexibility to see any dentist, or a DPPO with an extensive network may be the right choice for your needs and budget.
Coverage for Orthodontics
Many dental plans do not include orthodontic coverage. If your plan offers it, ensure you understand any restrictions that apply before you sign up for an orthodontic treatment plan.
Most dental PPOs, similar to health insurance PPOs, have an annual maximum, and you pay for anything over that limit. Some have a separate lifetime maximum for orthodontics costs, as well.
Dental health maintenance organizations (HMOs) and managed fee-for-service plans do not have an annual maximum or a limit on individual services. Still, they often have a smaller network of dentists to choose from. That may lead to higher out-of-pocket costs.
Coverage for In-Network Dentists
A dental insurance plan is an affordable investment that may help avoid costly procedures. With a plan, you’ll be able to get treatment quickly when needed, rather than having to save up or put the expense on credit.
Individual dental plans not offered as part of a health plan may have lower monthly premiums, deductibles, and annual maximums. These plans can also be portable, making them ideal if you work for multiple employers or are freelancers.
For example, an Insurance Company offers a variety of dental preferred provider organization (DPPO) plans for individuals and families, with a network of more than 89,000 locations and renowned customer service. Its plans include 100% coverage for exams, cleanings, and X-rays when you visit an in-network dentist.
Coverage for Out-of-Network Dentists
When choosing a dental plan, consider whether you want coverage limited to a specific network of providers. Suppose you opt for a dental Preferred Provider Organization (DPPO) or Dental Health Maintenance Organization (DHMO) plan. In that case, you’ll need to visit dentists within the plan’s provider network to get the most benefits from the policy.
Other dental plan considerations include cost, annual limits, and monthly premiums. Also, look into the types of procedures a plan covers, including periodontics, and whether it offers 100% coverage for preventive care. Most plans do. But some don’t. And some don’t cover orthodontics at all. Some even have stipulations about which treatments are covered.
Coverage for Dental Implants
Dental implants offer a permanent replacement for missing teeth. Some individual dental plans provide coverage for these services, which can help you avoid the need to use a loan or credit card to pay for care.
Look for a plan that lists implant coverage in its summary of benefits. These are usually listed alongside coverage for basic and major procedures. You may also want to check whether the policy has an annual maximum.
Some individual dental insurance plans are fee-for-service, reimbursing patients for a portion of their dentists’ charges. These are sometimes paired with a dental savings plan, which offers lower monthly rates and pre-negotiated discounts for enrollees.
Coverage for Orthodontics
Orthodontic coverage can be a massive benefit for adults who need braces. However, if you’re considering buying a dental insurance plan to cover orthodontics, be sure to check the specifics of that plan carefully.
Different dental plans have other structures that can affect what is covered, how much is paid, and when it’s paid. For example, indemnity plans allow you to choose any dentist but usually reimburse a percentage of your expenses.
Preferred Provider Organization (PPO) plans have a network of dentists with contracts to perform services for set fees. This can often be more cost-effective than an indemnity plan.
Harper Harrison is a reporter for The Hear UP. Harper got an internship at the NPR and worked as a reporter and producer. harper has also worked as a reporter for the Medium. Harper covers health and science for The Hear UP.
