There are various types of dental insurance plans. Preferred provider organization (PPO) plans are popular because they offer more flexibility with choosing providers and tend to be more costly than their alternatives.
A Dental Health Maintenance Organization (DHMO) plan may be less costly monthly, but only covers providers within its network. These plans also feature deductibles and coinsurance that must be met.
Premiums
Individual dental insurance plans can be costly. Their costs depend on your chosen plan type and coverage options, such as having a deductible, copays and percentage split between yourself and the insurer for services provided. It’s essential that you understand these terms before you purchase one, along with the maximum benefit limit per enrollment year (most PPO and indemnity plans have one while some HMOs don’t), such as Anthem Essential Choice Platinum plan from MetLife TakeAlong Dental High plan which has a maximum benefit limit of $2,000 for enrolleees enrolled on these plans).
Some types of dental insurance come with a deductible, a set amount you pay toward dental services before your insurance begins covering them. Some plans offer annual deductibles while others can have lifetime deductibles; usually the higher your deductible is, the lower your monthly premium will be.
Before selecting a dental insurance plan, carefully consider your visit frequency and care needs. Many plans provide coverage for preventative procedures like annual exams and cleanings with no out-of-pocket costs; more costly services, like fillings or root canals may require either waiting periods or sharing more of the cost with insurers.
Similar to health insurance plans, dental plans are divided into metal levels for easier categorization. Gold and platinum plans provide more comprehensive coverage with lower deductibles and out-of-pocket expenses; bronze and silver plans offer cheaper monthly premiums but typically feature higher deductibles and expenses.
As employers often receive group rates, purchasing dental insurance through work may be more affordable than purchasing it alone. Self-employed workers may be eligible to purchase individual coverage through professional associations or membership groups; many online providers also make it easy to compare, quote, and buy plans quickly while helping navigate any complex policies.
Deductibles
Most dental insurance plans feature an annual deductible, the amount you must pay out-of-pocket before receiving coverage. Deductible amounts vary between plans; therefore it’s essential that you understand their mechanism before signing up for coverage. Some providers such as Delta Dental do not have any deductible at all while others could have very high ones.
Dental insurance policies also typically come equipped with annual maximum coverage limits, or AMC. This number represents how much an insurance provider will cover in one year for any particular service or procedure, though limits may differ between plans; some may provide lower maximums while others might have waiting periods before certain treatments become covered.
Consider annual maximums and deductibles as well as co-pays when selecting a dental plan, since these costs can quickly add up. Most insurance providers also have fee schedules to determine how much they’ll reimburse for specific procedures based on average costs in your region.
Some private dental plans, like preferred provider organizations (PPO), negotiate fees with dentists to lower out-of-pocket expenses; these plans tend to come with higher premiums.
HMO plans may provide another alternative with lower monthly or annual premiums than their PPO counterparts, and cover only care from in-network providers with referral requirements and limited coverage of out-of-network treatments. By contrast, dental preferred provider organizations (DPPO) typically offer more flexibility and wider networks while typically boasting lower deductibles than HMO plans.
Finally, indemnity plans allow you to visit any dentist you want and have expenses reimbursed based on a percentage of the insurer’s usual, customary, or reasonable fee. Unfortunately, these plans tend to have higher out-of-pocket costs and may be harder to locate; these types of plans tend to be most popular with employers in terms of offering them as options (about half), with PPO/DHMO plans comprising the other half.
Co-pays
Individual dental insurance includes numerous variables to take into account when purchasing it, such as premiums, deductibles and co-pays. Many of these variables depend on which plan type is selected – each can have an effect on overall costs in different ways; for instance, Preferred Provider Organization (PPO) plans often offer lower costs than Exclusive Provider Organizations or HMO plans while an indemnity plan has higher premiums but no network restrictions, thus offering compensation at a reduced rate when services outside your network are rendered.
General, most dental plans cover at least 80% of basic procedures like fillings once you reach your annual deductible. Furthermore, many policies cover some percentage of expensive procedures like root canals or crowns; the remaining costs must be covered by patients themselves. Some policies have waiting periods before covering these costly procedures fully while others only partially do so once deductible is met.
Individual dental insurance coverage often follows a similar structure to health insurance plans, with monthly premiums, deductibles and coinsurance costs all factored in. Deductibles will usually depend on how many family members enrolling in the plan; with more comprehensive plans typically having higher deductibles and out-of-pocket expenses.
Example: If you select an individual plan with an individual deductible of $100 and 80% coverage for basic procedures, 20% of that cost, or $200 will need to be covered out-of-pocket. By contrast, selecting a family deductible of $250 allows insurance providers to begin covering basic procedures at a percentage of their actual costs – potentially saving hundreds each year on out-of-pocket expenses.
Many dental insurance providers now provide plans without or with low deductibles and coinsurance costs; these plans are known as dental HMOs. Similar to traditional health insurance plans, dental HMOs provide access to participating providers; you must visit an in-network dentist for most treatments; while these plans tend to be cheaper than others and allow greater choice when choosing your dentist.
Coinsurance
Costs associated with dental insurance depend on a range of factors, including premiums, deductibles and copays. Overall cost may be less than health care plans due to lower annual maximum and coverage limits; plus many preventive dental services don’t incur copayment or deductible expenses, making the added expense worth while for most consumers.
Before choosing a Marketplace dental plan, it’s essential to compare costs between plans in order to find one that is within your budget. While some plans feature higher monthly premiums or lower premiums with increased deductibles or copayments, others might offer more affordable coverage with lower premiums but higher deductibles or copayments.
Dental premiums vary based on your plan type, coverage level and network of providers. Plans that permit you to select any dentist tend to have higher premiums but provide greater freedom. Preferred provider organization (PPO) or dental health maintenance organization (DHMO) plans typically offer lower premiums but have restrictions in which dentists they accept as patients.
As with health insurance plans, dental plans’ costs may also depend on their metal level – much like health insurance plans’ metal levels – with plans with higher metal levels typically having higher deductibles and MOOP costs; however, they could potentially have lower out-of-pocket expenses.
Before purchasing dental insurance, it is important to carefully consider its cost. While having dental coverage may save money on routine procedures, its additional expense might not always justify itself in more extensive procedures – most plans won’t cover more than half the costs for crowns alone which can cost as much as $5,000! In such instances it might be wiser to build an emergency fund or health savings account so you can pay out-of-pocket.
If the costs associated with comprehensive dental plans are beyond your means, consider opting for a basic plan which covers essential services like cleanings and X-rays. Although such plans don’t offer as extensive a network of dentists as full coverage plans do, they still represent significant cost savings compared to paying out-of-pocket for these procedures.
