It’s a fact: People who have dental insurance are more likely to see a dentist twice a year and address problems with their teeth in a timely manner. That’s because most dental insurance plans cover most or all the cost of twice-yearly exams and make addressing problems with your teeth more affordable.
Regular dental care, included as a covered benefit in most dental insurance plans, is vital. Preventive cleanings and treatment care can help head off issues with your teeth. In addition, catching dental problems such as cavities early can save you from painful and expensive treatments later.
Regular exams also can save your life. Studies have shown that those with gum disease (also known as periodontal disease) have two to three times the risk of having a heart attack or stroke. Regular cleanings also can help prevent gum disease or catch it in its early stages. In addition to looking at the condition of your teeth, your dentist also will look for signs of oral cancer by examining the area under your jaw, the sides of your neck, the insides of your lips and cheeks, sides of your tongue and the roof and floor of your mouth.
There are two main ways to get dental coverage:
Dental insurance as part of your health plan. Some major medical insurance plans include dental care. If dental insurance is part of your health plan, you’ll pay one premium a month for both health and dental.
Stand-alone dental insurance. With a stand-alone insurance plan, you’ll pay two separate premiums; one for health insurance and one for dental insurance, with another set of providers.
When shopping around, you’ll have the choice of an Indemnity Plan, a Dental Health Maintenance Organization (DHMO) or a Preferred Provider Organization (PPO).
Stand-alone dental plans are also available to purchase without a health plan. However, just as it’s not advisable to go without dental insurance, it’s not advisable to forego health coverage either.
With an Indemnity Plan, you can see any provider you wish. Plan members are reimbursed for a pre-specified amount for the services that were provided. Members must pay the difference. For example, if the plan covers $200 toward the cost of a dental exam, and the exam costs $250, the plan member would pay the $50 difference.
With a Dental Health Maintenance Organization, a plan member must visit a dentist that is in the DHMO’s network to receive the benefits of reduced-cost or no-cost exams and discounted treatment. DHMOs typically have no out-of-network benefit, meaning you will pay full price for seeing a dentist that isn’t part of the DHMO’s network.
Like a DHMO, members of PPOs have a network of dentists to choose from. Members who select a dentist who is outside the preferred network will pay higher prices for services.
When shopping for a plan, you’ll also have the choice of high and low coverage levels. With high dental insurance coverage, you’ll pay a higher premium but have lower copayments and deductibles. With lower dental coverage, you’ll have a lower premium but higher out-of-pocket costs.
There are two important facts to keep in mind when purchasing dental insurance through the Health Insurance Marketplace. The first is that you cannot purchase this type of insurance through the Health Insurance Marketplace unless you are also enrolling in a health plan at the same time. The second: Stand-alone dental plans do not qualify for a tax credit. A tax credit, however, can be applied to the premium of a major medical plan that also includes dental coverage.
As with health insurance, at Health Choice One, we offer a variety of dental plans. One alternative to traditional insurance is a dental discount plan. With a dental discount plan, you pay a yearly fee, which provides access to pre-negotiated discounts with dental providers. Dental discount plans are less expensive than dental insurance. There are no monthly premiums; the cost of the plan is paid once yearly.
With a dental discount plan, you simply visit a provider that contracts with the plan, provide them with your discount card and pay them directly for the discounted cost of the dental exam or treatment. There are no copays, deductibles, or coinsurance.