Dental Insurance

Learn how to find the best dental insurance plans for individuals, families, and more. Before you compare dental insurance quotes, arm yourself with the basic knowledge of how dental plans work, so you can choose the best and most affordable dental insurance for your needs.

Dental insurance is simply insurance designed to pay all or, more usually, a percentage, of the costs that associated with dental care. It works much the same as medical insurance or, indeed, any insurance policy/plan: You pay a specific monthly rate (called a "premium") in return for certain benefits. Usually, the higher the premium you're willing to pay, the broader the range of benefits you receive. In the case of dental insurance, those benefits can include (but are not limited to): regular check-ups, teeth cleaning, mouth x-rays, and a number of other services in the area of preventative dental care too. Some policies can also include certain types of dental surgeries, orthodontic care, and dental implants.

There's no industry-standard that says for X premium, you receive X benefits. So-called "full coverage dental insurance" is as good as it gets; you'll receive maximum benefits to cover most eventualities. However, as you might expect, this type of insurance is the most expensive. That said, the exact range of cover and the various limitations applied to this, and other types of dental insurance polices, are determined by each insurance company, and, in addition to your ability to pay for them, depend greatly on individual circumstances and personal (dental) history.

Dental Insurance Plans:

It can be difficult to compare dental insurance plans simply because there are a multitude of them on the market... some are designed specifically for individuals, others to cover whole families, and some are even available for entire groups of (otherwise unrelated) people, such as the employees of a large business or government agency. And, similar to health insurance, all dental insurance plans are generally sub-categorized as either "managed-care" or "indemnity" plans too. The difference between both relate to how dental bills are paid, what up-front costs you have to bear before filing a claim, and what choice of dental care providers you'll have to choose from.

Managed-care dental plans are better known as...

Dental PPO (Preferred Provider Organization) Plans:

A dental PPO plan generally involves the least amount of paperwork for the patients, as well as less up-front cost too. Such plans involve a network of dental professionals (which are the "preferred provider" organizations) who have already agreed to carry out their services for patients at pre-set costs and will (usually, though not always) complete and submit the relevant paperwork to the dental insurance company for you. While available throughout the United States, they are especially common in California, Texas, and New York.

When you visit PPO dentists, you pay them a smaller percentage of their rate (called "coinsurance") and your insurance company pays the rest. The coinsurance percentage varies according to each dental plan. For example, when received preventative dental services like teeth cleaning, you may only have to pay the dentists 20% of what he usually charges, and your insurer pays him the rest. For major services, like crowns and bridges, you might have to pay 50% instead. Again, it varies considerably according to your individual dental insurance plan.

Also, PPO plans usually include a deductible (which is a certain amount of out-of-pocket expense you'll have to pay anyway, before the insurance company pays its part), and generally have a maximum amount of coverage per annum (meaning anything above that maximum won't be covered by the insurance company).

Despite that, a dental PPO plan still usually involves the lowest out-of-pocket expense for you when receiving dental services. However, the big disadvantage of these type of plans is the limited range of providers you can choose from; if you receive treatment from a provider not pre-approved by your insurer, you won't receive any coverage for their services at all.

On the other hand, an indemnity dental plan will offer a very large range of providers to choose from. Indemnity plans are also known as traditional, or fee-for-service, plans.

Fee-For-Service (Indemnity) Dental Plans:

Indemnity dental plans are similar to PPO plans in that you also only pay a percentage of the total fee up-front (again, this is called "coinsurance"). Also, like PPO plans, the exact percentage varies according to plan and the type of dental treatment you are receiving. However, the big difference is that the dental insurance company pays for less of each individual treatment, meaning that your coinsurance will be (sometimes considerably) more than on a PPO plan.

Also, on some indemnity plans, your coinsurance is 100% or, to be more correct, there is no co-payment involved at all; the dental insurance company will only pay after they receive a bill, which means you'll have to pay the dentist his entire fee up front, and then re-coup whatever portion of that fee is covered by your dental plan by filing a claim for it later.

Aside from these types of traditionally-available plans, a more recent innovation on the market are  so-called Dental Health Maintenance Organization (DHMO) plans or, simply Prepaid Dental Plans:

Prepaid/DHMO Dental Plans:

Prepaid, or DHMO, plans are different in that they require you to select a primary care dentist, from whom you will receive all your dental care. That dentist will also refer you to a specialist as needed (though such specialty care will usually require pre-authorization by your insurance company first).

There typically is no deductible, or maximum claim limit, involved with DHMO-type plans. Usually, you simply pay a fixed amount for any particular treatment you receive. Some diagnostic services and preventative treatments don't involve any up-front payment at all; they're entirely covered by the plan.

Prepaid plans are a very affordable dental insurance option for both individuals and families. The only significant downside is that if you visit a dentist other than your primary care providers (or someone to whom they refer you), then you won't be covered by your insurance plan at all, and will have to pay the entire bill for such services.

Discount Dental Plans:

While not actually an insurance policy, a small number of insurance providers also offer reduced-fee-for-service plans, otherwise known as a discount plan. A discount plan involves a monthly or annual charge in return for a discounted rate for services from participating dentists.

They don't involve any paperwork, deductibles, or annual claim limits; however, the discounted rate is only available from dentists participating in such schemes, and the discounted rate is generally higher than the portion of treatment costs usually covered by PPO, indemnity, and prepaid dental insurance plans.

The Best Dental Insurance Plan For You:

Actually, there is no one best dental insurance plan; some will be better suited to you than others. Plans differ primarily in how much your monthly (or, in some cases, annual) premium will be, and how much you'll have to pay up-front for various treatments. However, they also very according to individual need; for example dental insurance for seniors will obviously be very different to that intended for children or even just younger adults. Also, a dental plan for a whole family will obviously differ to that required by one individual.

Before you compare dental insurance quotes to decide which is the best plan for you, take the time to collect old invoices and statements from your current dentist or insurance company to get some idea of how much you spend on dental care right now. Also consider likely additional expenses that will arise in the near future; for example, is your child going to need braces soon?. Having such basic information to hand will help you fully consider the available options.

Your should also consider the following when comparing different dental plans:

• How much will the premium be? The premium is the amount you'll have to pay each month (or, in some cases, per annum) to buy a particular dental plan in the first place. It varies considerably according to the level of benefits you'll receive on each individual plan. For example, if your deductible will be low and the maximum annual claim limit high, then you're premium would be higher than if the deductible for higher and the annual limit lower. Simply put: the more you're willing to pay, the more you'll receive in return.
• Is treatment by your current dentist covered by the plan? Check to see if the dentist you currently use is part of the plan's network. If not, will you be comfortable changing dentist? And, if you do change dentists, will your new dentist be conveniently located? For example, what if the nearest dentist covered by the plan you're interested in is located a hundred miles from where you live? Will the benefits you receive on that plan be worth the time, expense, and effort required to travel that far to avail of their services? 
• Is there a deductible, and how is it applied? Most dental insurance plans feature a deductible, which is the amount you'll have to pay towards dental services before the dental plan pays anything at all (above which it then pays a percentage (or, in some cases, all) of the cost for different services, in the manner specified in your plan benefits). However, some dental plans exclude specific services (like cleanings, for example) from this meaning that, even if you haven't met your deductible, the insurer will still pay out anyway.
• Is there a maximum amount of coverage? Most dental plans have a maximum amount it will pay out for services received by you in any one year. Also, most also have a maximum lifetime amount for things such as braces. Is the plan you're interested in going to be sufficient to cover your future estimated expenses?
• What about "out of network" coverage? Most dental plans only cover treatment provided by a list of pre-approved providers. However, what if you need emergency treatment from a dentist outside of that network? Some plans do feature full or partial coverage for treatment provided by an "out of network" dentist on an emergency basis; check to see if the plan you're interested in does likewise.
• Are there waiting periods for specific treatments involved? Some plans require waiting periods before you can avail of certain treatments. For example, you may need to be covered for 6 months (or even longer) before being considered eligible for orthodontic coverage. Consider what dental services you're likely to need in the near future - are you comfortable with having to wait a certain period before you can receive the treatment you'll need on your preferred dental insurance plan?