Individual Dental Insurance: Your Guide to Choosing a Plan

A Man Searches Online for an Individual Dental Insurance Plan

Dental insurance typically covers the cost of preventative dental care, such as teeth cleanings and oral exams, and it also helps cover a portion of other treatments, such as fillings and root canals. However, 27.5 percent of adults in the U.S. don't have any dental coverage, according to the American Dental Association Health Policy Institute. If you don't have dental insurance and need coverage for yourself, you may want to explore an individual dental plan.

Types of Individual Dental Insurance Plans

Dental insurance is available in many forms, such as employer-sponsored group plans for employees, or family plans intended to cover multiple people. For those who don't get dental insurance through their employer and don't need a family plan, individual dental insurance could be a good option.

Underneath the umbrella of individual dental insurance, there are different plans. The best type of insurance plan for you depends on your personal preferences and whether you want to pay more for insurance premiums — the monthly payment you'll make — or more for the cost of care at the time of your treatment.

America's Health Insurance Plans (AHIP) divides dental coverage into three types:

  • Dental Health Managed Organizations (DHMO)

    If you purchase a DHMO plan, you'll choose a dentist in the plan's network to serve as your "primary provider." This plan covers visits to your primary provider or treatments from a specialist that your primary dentist refers you to.
  • Preferred Provider Organizations (PPO)

    With a PPO, you don't have to choose a primary provider. As long as you see a dentist or specialist who is in the plan's network, your care is covered at the best rate. Visiting a dentist outside of the network will cost you more.
  • Indemnity Plans

    Indemnity plans are sometimes called "fee-for-service" plans, as the American Association of Endodontists notes. An indemnity plan lets you go to any dental provider you want, and your plan will pay a set percentage of the cost of care.

Cost of Dental Insurance

Dental insurance plans often differ when it comes to the procedures they cover and the out-of-pocket costs you have to pay.

Most dental insurance plans will cover 100 percent of the costs for preventative care, according to the American Dental Association. These routine procedures include cleanings, X-rays, exams and sealants, explains AHIP. They will often also cover some of the expenses related to nonroutine procedures, such as teeth replacement, cavity treatments and root canals. Dental plans usually don't cover cosmetic treatments such as teeth whitening.

Before choosing an individual dental plan, you'll need to look at the different cost considerations:

  • Deductible

    Some plans have a deductible, which is the amount you need to pay upfront before insurance starts covering expenses.
  • Co-Payments

    DHMOs often require a co-payment, which is a fixed cost you pay to your provider at the time of your appointment, according to AHIP.
  • Co-Insurance

    PPOs and indemnity plans may have a co-insurance charge, which is a percentage of the cost of treatment that you need to pay.
  • Premium

    This is the monthly amount you owe your insurance provider for coverage. Usually, the more you pay out of pocket for care, the less you pay to the insurance plan as a monthly premium.
  • Annual Maximum

    Many plans have a maximum coverage amount and won't pay for treatments that exceed that amount within a given year.

Finding an Individual Dental Plan

AHIP explains that you can find individual dental plans through an insurance agent or by searching online. Before opting for an individual plan, check that you don't qualify for an employer plan or federal programs such as Medicaid or the Children's Health Insurance Program.

As you're researching your options, here are a few questions to ask:

  • Is your current dentist in-network, or will you have to switch providers?
  • What costs are you responsible for paying? Are there deductibles, co-payments or co-insurance?
  • What is the monthly premium?
  • How much coverage does the plan provide?
  • What treatments are covered?

Although dental insurance can seem like an unnecessary extra expense, it can pay off in the long run. Preventative dental care helps to keep your mouth healthy, and the right dental insurance can help you manage and reduce the cost.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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What To Expect During a DENTAL VISIT

On your first visit, your dentist will take a full health history. On follow-up visits, if your health status has changed, make sure to tell your dentist. Here’s what you can expect during most trips to the dentist.

  • A Thorough Cleaning – a dental hygienist or dentist will scrape along and below the gum line to remove built-up plaque and tartar that can cause gum disease, cavities, bad breath and other problems. Then he or she will polish and floss your teeth.

  • A Full Dental Examination – your dentist will perform a thorough examination of your teeth, gums and mouth, looking for signs of disease or other problems.

  • X-Rays – X-rays can diagnose problems otherwise unnoticed, such as damage to jawbones, impacted teeth, abscesses, cysts or tumors, and decay between the teeth.