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Dental Insurance 101: Important Facts You Should Know

When it comes to dental insurance, knowing what you get for your money will help you find the coverage that is right for you.

You may be asking yourself if you should get dental insurance. What kind of plan you should get. If it will cover your entire family. If you will be able to choose your own dentist.

Dental insurance can be complicated and confusing if you don't have a good understanding of the different types of coverage and dental plans that are available.

By learning more about dental insurance, you can make sure that you get the coverage you and your family need at a reasonable cost. 

Overview of Dental Insurance

Before we get started on the nuances of the dental insurance game, it is a good idea to look at the bigger picture to make sure that you understand what you are looking at when it starts to get complicated.

Dental care coverage providers often use specialized terms to describe their benefits, programs, plans and coverage. You will need to read the fine print of any plan since coverage differs greatly from policy to policy.

In general, basic dental insurance will cover preventive and diagnostic dental care and basic dental procedures. This means that your provider will cover the majority of expenses associated with dental cleanings, regular dental visits and preventive dentistry procedures as well as restorative dentistry procedures such as a tooth filling, tooth extraction and chipped tooth repair.

Your provider may or may not fully cover root canal therapy and other more complicated procedures, so make sure that you get all the information about their specific policy. Most dental insurance providers will also partially cover major dental care such as dental surgery, orthodontics and dentures.

When you start to think about what sort of coverage is right for you, it is important for you to consider what level of care you want your provider to cover and try to balance this with the costs of the insurance.

PPO vs. HMO

If you are interested in full-coverage dental insurance, you may have to choose between a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO). PPO and HMO plans are the most popular types of dental plans and are commonly available to employees through their company's benefit package, although they can be acquired by individuals.

A PPO plan provides coverage through a network insurance system. You pay a premium for coverage and PPO plans will usually pay for most of your dental expenses with a low deductible. A PPO dental plan also gives you the flexibility to visit dental care providers who are out-of-network, although you may save money if your dentist is in-network.

An HMO plan works much like a PPO plan. You pay a premium for coverage and then you can choose from a number of in-network dental care providers. The major difference between the two plans is that, with an HMO plan, you get no coverage if you visit an out-of-network dental care provider and will have to pay your entire dental bill yourself. For this reason, HMO plans are often less expensive than PPO plans.

As with any type of dental insurance it is important that you get all the facts before enrolling in a PPO or HMO plan so that you know exactly what is covered and what you will have to pay in premiums and deductibles.

Other Options

Dental insurance indemnity plans are another common form of dental insurance. Indemnity dental plans allow you to visit any dental care provider that you choose and pay a deductible on the care you receive. The provider will cover a large portion -- or the entirety -- of the costs for most routine and customary dental care.

Different providers will have different definitions of what constitutes "usual and customary" dental care so it is important that you know exactly what a given plan covers before enrolling. Indemnity plan providers also vary in the amount of care costs that they cover so make sure to read the fine print.

Another form of dental insurance is an exclusive provider organization (EPO). An EPO works much like an HMO. You will have a list of in-network dental care providers to choose from and will not be covered for out-of-network service. Unlike an HMO, an EPO provider pays dentists for each service provided rather than a monthly fee for all policy holders, regardless of services performed.

As with most dental insurance plans, EPO plans only cover certain dental services, so it is important for you to find out exactly what a given provider will cover.

State Aid

If you're unable to afford dental insurance, your dental health doesn't have to suffer. Low-income families are eligible to receive government-funded medical care known as Medicaid or State Aid. Dental care services for State Aid recipients are optional if you're over the age of 21 but mandatory if you're 20 years old or younger.

The dental care services covered by State Aid vary from state to state for adults, but there is a compulsory program that helps ensure proper dental care for your child. Called the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, it focuses on prevention, early diagnosis and dental treatment for all eligible children.

Depending on your income level and other criteria, State Aid may pay some or all of your dental care and medical health expenses directly to your healthcare provider. To find out if you're eligible to receive State Aid medical benefits, be sure to contact your state's public health department directly.

When you're ready to choose a dentist, we can help!