Find the Best Dental Insurance Companies

On average, dental insurance costs $14–$30 per month for an individual or $27–$56 per month for a family. In addition to a monthly premium payment, there is usually a co-payment at each visit and a coinsurance responsibility. Your dental insurance plan might include two routine cleanings, which can cut down on additional dental procedures throughout the year.

• Deductible: This is a specific dollar amount customers have to pay out-of-pocket before the insurance company begins making payments for any claims. It is not part of the copayment.
• Copayment: This is a fixed amount paid at the time of the dentist’s visit. It is a separate charge and not applied toward your deductible, which you need to reach before insurance kicks in.
• Coinsurance: Given as a percentage, coinsurance is what the client has to pay after satisfying the co-payment and/or deductible for the plan. This can vary for different services.
• Maximum out-of-pocket cost: Maximum out-of-pocket cost represents the total amount policyholders will have to pay for dental care throughout the year.

Dental insurance coverage

In general, dental insurance plans cover preventive care and basic procedures. It is important to sign up for a dental insurance plan that covers any procedures needed in the near future. So, it is crucial to check the benefits and services offered before choosing the best dental insurance plan for your needs.

• Preventive care/exams: There is usually coverage for preventive care services such as routine oral examinations, periodontal examinations, X-rays, general cleanings, topical fluoride treatment and sealants.
• Basic procedures: Basic procedures, such as emergency care, extractions, fillings, space maintainers, minor oral surgery and crowns, are sometimes covered. For good coverage of basic procedures, consumers may need to pay more.
• Major procedures: Generally, only top-of-the-line coverage handles major services. Common major procedures that are covered by more comprehensive dental insurance plans include crowns, bridgework, dentures, periodontal cleanings, gum therapies and root canals.

Dental insurance exclusions

From gold crowns to failure to keep an appointment, dental insurance companies always write in a list of exclusions. You’re responsible for reading and understanding what’s on your insurer’s list.

• Cosmetic dentistry: Teeth whitening, bonding, enamel shaping and contouring, dental implants and orthodontics are some examples of cosmetic services that are typically not covered by plans.
• Annual maximum benefit: The maximum benefit refers to the highest dollar amount the dental insurance firm will pay per family member per year. It is usually a part of PPO plans. This is a very important consideration as the cost of major oral surgery, once the maximum annual benefit exceeded, could fall mainly the patient's responsibility with such a plan.
• Specialties: Basic dental plans typically exclude orthodontics, endodontics, periodontics and prosthodontics.
• Discounted rates: Discounts passed along by in-network dentists may not be available in some states.
• Standalone dental: Depending on the state in which you live, some insurers will not let you buy dental coverage unless you are also covered by one of the insurer’s medical plans.
• Special circumstances: Dental insurance companies even exclude services that may be needed due to special circumstances, among which may include losses from armed conflict, self-inflicted injuries and infections.
• Waiting periods: Some basic dental services may incur a six-month waiting period and some major services may incur a 12-month waiting period.

Traditional plans

Also known as indemnity or fee-for-service plans, traditional dental insurance involves the patient paying a percentage of the total cost and the insurance company paying the rest. These plans usually have a co-payment, deductible and maximum out-of-pocket cost. You may have to pay for services up front, file your own claims and wait for the insurance carrier to reimburse you, but this type of plan offers the largest choice of dentists. Indemnity plans are usually pricier than other plans.

DPO/PPO plans

Dental Plan Organization/Preferred Provider Organization (PPO) plans utilize an in-network list of dentists to provide services to patients at a negotiated reduced rate, and patients pay a percentage of that reduced rate. Each plan usually requires first meeting a deductible. These plans come with an annual maximum benefit.

DHMO/Pre-paid plans

Dental Health Maintenance Organization (DHMO) plans also utilize an in-network list of dentists to offer services to patients at a negotiated discounted price. Generally, patients only see one dentist for oral health needs and can be referred for specialty care. With a DHMO plan, there may or may not be an annual maximum benefit limit and deductibles are not a part of the plan. Instead, you’ll pay fixed dollar amounts or copayments for treatment. These plans can be very affordable for those looking for basic services; however, there may be limitations for major procedures. If you visit an out-of-network dentist, you may be responsible for the entire bill.

Supplemental

Supplemental dental coverage is a separate dental plan that covers procedures not covered by a basic dental plan.

Non-insured discount plans

Discount plans are not actually insurance. These plans simply offer a discount off the sticker cost for dental care, and there is little or no paperwork, annual limits or deductibles so long as patients visit a participating dentist. This option is good for those who do not require or want consistent oral health care.

Each insurer partners with various dentists throughout certain states and regions. Dentists perform services according to a rate schedule, which is a set fee agreed on by the provider and insurer. People usually pay less when the visit a dentist in an insurer’s network. Customers switching insurers may want to double check if their dentist is in the new insurer’s network. Conversely, if switching dentist, customers should check to see if the new dentist belongs to the patient’s insurer’s network.

• In-network list: Before purchasing a plan, customers should look over the list of in-network dentists and make sure there is an in-network professional in their area.
• Financial incentives: Under certain plans, patients save lots of money by going to in-network dentists. Other plans may even refuse to cover care from out-of-network dentists.
• Flexibility: To satisfy customer needs, some dentists and plans are willing to make exceptions for patients when it comes to network coverage.