Dental Coverage: Get the Facts

March 1, 2018

Editor’s note: This post was originally published on 11/15/16 and has been updated for accuracy and comprehension.


Whether it’s a cleaning, a crown or a cavity, dental costs can add up. A dental insurance plan can help offset costly expenses you incur for having dental work done.

If your employer doesn’t offer dental coverage or your marketplace plan currently doesn’t include it, you can access personal or standalone dental coverage.

Here’s what you need to know.

How to get it

There are two ways to get dental coverage:

  • Purchase a marketplace health plan that includes dental. Examine a few options and compare coverage and price. Keep in mind, however, that you’ll only pay one premium for a health plan that includes health and dental coverage.
  • Purchase standalone dental coverage. If you’re not satisfied with your dental coverage, or you don’t currently have a plan, you can buy it as a separate product. As a separate plan, keep in mind that you’ll pay a separate premium for the coverage.

Comparing plans

In the marketplace, there are two types of coverage: low and high coverage.

  • Standard coverage offers beneficiaries a lower premium with no deductible. Provides coverage for routine cleanings, oral exams, and bitewing x-ray.
  • Premium coverage is the opposite. You’ll pay higher monthly premiums for more comprehensive coverage. In addition to preventive services, plans can include coverage for complex procedures like fillings, root canals, simple extractions, crowns, dentures, and bridges subject to a waiting period of up to 12 months.

Be sure that as you compare standalone dental plans you pay close attention to the monthly premium, the deductible, copays, and waiting periods for complex procedures. Be sure you choose a plan that you can afford while providing sufficient coverage for you and your family.

Is it essential?

The Affordable Care Act outlines dental insurance as essential for children, but not adults.

  • Children. If you’re looking for a plan for your child, the carrier must provide dental coverage within the plan or a standalone policy.
  • Adults. Insurance carriers, however, are not required to offer you, as an adult, dental coverage.

As opposed to health coverage, which is required for everyone by law, dental coverage is optional for everyone. If you don’t purchase a dental policy, you won’t incur a penalty.

However, going without dental coverage could lead to neglected dental hygiene, health problems, and, down the road, bigger expenses.

What are the options?

There are three general types of standalone dental plan designs:

  • Indemnity plans work well if your dentist isn’t in your network and you want to continue going there. The plan will pay your dentist a percentage of the service, and you will be responsible for the rest.
  • Dental health managed organization (DHMO) plans are an arrangement between the healthcare provider and the carrier. The provider agrees to provide services at a lower cost for in-network patients. Some plans will offer free preventive services.
  • Participating provider network (PPO) works much like a DHMO, with a provider offering reduced fees for in-network services. However, a PPO lets beneficiaries use providers that are out of network and non-participating. Use of out-of-network providers will require the member to pay more and be responsible for fee differences.

Dental insurance is a significant contributor to good health. If you’d like to explore your dental insurance options, contact InsureOne Benefits today!

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