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Choosing Dental Insurance: 8 Tips For Finding The Right Plan



Even though you brush and floss your teeth daily, you still need dental insurance to help protect your smile. Dental plans cover annual preventive exams that include a professional teeth cleaning. This is vital because tartar buildup cannot simply be brushed away. The dentist also will check your teeth and oral tissues, and look for signs of dental problems that can affect overall health. If the dentist identifies the need for a filling, crown, root canal or other procedure, dental insurance helps offset these unexpected costs.


You may be offered dental insurance through an employer. If not, consider an individual plan. Also, every dental insurance plan covers procedures in different ways. So, when choosing dental insurance, here are eight tips for finding the right plan.


  • Medical insurance with dental

Some medical plans include dental coverage. But the plan usually covers only a portion of the cost for cleanings and checkups. Other expenses, such as fillings, crowns, or root canals, may not be paid unless the medical deductible is paid first.


  • Waiting periods

Check if the dental plan has a waiting period before covering some procedures. The waiting period can be several months to a year. However, some dental insurance plans, through Ameritas for example, offer day-one benefits. So, members can start using their coverage on the first day of their new plan. To lower costs, some plans may offer a waiting period on Major/Type 3 procedures. It just depends on the plan.


  • Annual maximum benefit

Most plans have a maximum yearly coverage limit. This is known as the annual maximum benefit. It’s the amount insurance will pay each year toward covered procedures. Members would pay the rest. But the good news is this dollar amount is available to you each benefit year. So if you can time your necessary dental procedures from year to year, it can help a lot.


  • In- and out-of-network

Most dental plans offer in-network benefits through participating providers who agree to accept a set payment amount from the insurance company for each covered service. For out-of-network providers, insurance plans usually cover part of the cost and members pay the rest.


  • Deductibles and copays

Many plans have a copayment or deductible. A copay is a set amount members pay at each doctor’s appointment. A deductible is the amount members must pay before the insurance plan pays. Generally, there is no copay or deductible for preventive procedures.


  • Covered procedures

Many dental plans do not cover all dental procedures, especially those considered cosmetic. Before scheduling a dental procedure, check with the plan’s customer service representative to verify coverage. This information will help members get the most from their dental coverage and avoid unexpected out-of-pocket costs. There also are different benefit levels for covered procedures. For instance, Preventive/Type 1 usually is covered at 100%, Basic/Type 2 at 80% and Major/Type 3 at 50% (traditional plan). Ultimately, dental costs are determined by the member’s oral health. Knowing this helps identify the type of dental insurance plan needed. For example, people with healthy mouths may need only a basic plan that covers preventive services, and one or two fillings each year.


  • Rewards and incentives

Some dental plan designs include a rewards feature where members can increase their annual maximum benefit over time. For example, they could qualify to carry over up to $350 in unused benefits that can be applied to future dental claims. Without this feature, the plan’s annual maximum benefit resets every year with no increase (rewards carryover). Check whether the plan you’re considering has this feature.


  • Insurance carrier reputation

Before committing to a dental insurance plan, check the reputation of the carrier providing the coverage. Find out whether customers are satisfied with the coverage, and how many customers stay with the carrier after the first year. Also find out how long they’ve been in business, and how fast they pay claims.