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Dental Insurance – All you need to know

September 5, 2022

Dental Insurance – All you need to know

Consumer demand for dental insurance in the U.S. is on the rise, and it’s increasing due to a growing prevalence of tooth decay as well as an increased awareness about the importance of oral hygiene. But – just like individual health insurance – your access to dental health insurance and dental coverage options can vary a lot depending on where you live.

What is dental insurance?

Dental insurance is insurance that covers a portion of basic dental expenses that you may encounter during a typical year, paying for procedures and treatments that generally improve and maintain your oral health.

Dental insurance is similar to health insurance in that:

  • You pay a monthly premium for dental coverage
  • Your dental plan will typically have a deductible
  • Your dental plan may have preferred providers with specific networks

What does dental insurance cover?

The benefits and cost of your dental coverage will depend on whether your plan is offered by an employer, obtained through the health insurance marketplace, provided as part of your state’s Medicaid program, or purchased directly from a dental insurance company.

Your policy will likely give you access to free or very low-cost cleanings and routine exams. And it will probably cover a portion of the cost of fillings and extractions after your deductible is met.

Many plans will also pay some of the cost of more extensive dental work, such as root canals, crowns, implants, endodontics, and periodontics. But the plan may have a waiting period for these services, or may cover a larger percentage of their cost after your plan has been in effect for a certain amount of time.

Some dental plans include benefits for cosmetic orthodontia services, although this is more common for employer-sponsored dental plans than self-purchased dental plans. Under pediatric dental coverage obtained via a health insurance marketplace, orthodontia will generally only be covered when considered medically necessary.

What Doesn’t Dental Insurance Cover?

Dental insurance doesn’t typically cover cosmetic dental services, which are considered not medically necessary. These procedures include any dental procedure that is done for aesthetic reasons, such as teeth whitening or non-essential veneer placement, and they could leave you with a significant out-of-pocket expense.

What are the costs of dental insurance?

Dental insurance premiums

For Americans who purchase their own stand-alone dental coverage, premiums are most commonly in the range of $20 to $50 per month. There are plans as low as $10/month, but to have any real coverage for major services, such as crowns and bridges, you should expect to pay at least $35/month.

If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies).

Types of Dental Insurance Plans

There are many different types of dental insurance plans, each with different benefits and out-of-pocket costs. Some offer a large network of dentists for a higher monthly premium while others have a lower monthly premium but require more out-of-pocket expenses for certain procedures.

The three most common types of dental insurance plans include:

  • Preferred provider organizations (PPOs).  The most common type of plan, a PPO uses a network of dental providers to provide care for an agreed-upon fee. Using an out-of-network dentist with this plan will cost more out of pocket.
  • Dental health maintenance organizations (DHMOs). A DHMO pays the network of dental providers a set monthly fee regardless of whether you choose to receive dental care. Some services are covered 100% while others may require you to pay a small copayment.
  • Discount or dental savings plans. These plans are sold to you by a company contracted with a group of dental providers agreeing to discount their dental fees. Most of these plans include cosmetic services, and you pay for treatment at the discounted rate determined by the plan.

About CMR | PolicySmart®

PolicySmart’s risk management consultants provide independent group benefit, retirement and commercial insurance advice by reviewing your current portfolio of policies to improve coverage and reduce cost. By using our proprietary database – The CMR Database® (comprising some 13,000 brokers and specialists globally), we maximize access to the insurance and retirement industry providing greater options that will translate to better coverage and lower cost.

Please email croche@policysmart.com or call 888-873-1982 or 212-447-4300 for more information.  www.policysmart.com



About CMR | PolicySmart®

CMR & Associates’ risk management consultants provide independent group benefits, retirement and insurance advice by reviewing your current plans to improve coverage and reduce cost. Through CMR’s proprietary database – The CMR Database® (comprised of some 13,000 brokers and specialists globally), we maximize access to the insurance and retirement industry for greater options that will translate to better coverage and lower cost.