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Individual Dental Insurance 101: Your Guide To Choosing A Plan

Dental insurance typically covers the cost of preventive dental care, such as dental hygiene treatment and oral exams. Dental insurance can also cover a portion of other therapies, such as fillings and root canals. Learn the differences between insurance plan types, common vocabulary to know, and how to compare plans to find the best fit.

How Dental Insurance Works

Dental insurance is available in many forms, such as group plans for employees through their employer, family plans intended to cover multiple people, and individual plans. Depending on the plan, the insurance benefits will wholly or partially cover dental treatments and services.

Types of Dental Insurance

Individual dental insurance plans have different options. According to America's Health Insurance Plans (AHIP), dental coverage is divided into three types:

  • Dental health managed organizations (DHMO)
  • Preferred provider organizations (PPO)
  • Indemnity plans

Dental Health Managed Organizations (DHMO)

Under a DHMO plan, you'll choose a dentist in the plan's network for your primary provider. DHMO will typically cover visits to your primary provider or treatments from a specialist once your primary provider makes a referral.

Preferred Provider Organizations (PPO)

You don't have to choose a primary provider under a PPO plan. As long as you select a dentist or specialist within the plan's network, your care is covered. You can still visit a dentist outside the network, but the visit could cost more.

Indemnity Plans

You're free to use any dentist you choose under an indemnity plan. These plans are sometimes called "fee-for-service" plans. You will pay a co-pay and a premium, and then the plan will cover a certain percentage of the cost of treatment.

Cost of Dental Insurance

According to the American Dental Association, most dental insurance plans will cover the costs for preventive care. Preventive care procedures include dental hygiene treatment, some X-rays, exams, and sealants. Dental insurance will often also cover some percentage of the expenses related to non-routine procedures like fillings, teeth replacement, other cavity treatments, and root canals. Coverage for cosmetic treatments like teeth whitening and orthodontics for adults will vary.

Dental Insurance Terms to Know

Before choosing an individual dental plan, here are some definitions for standard terms you will find in the details of dental insurance plans:

  1. Deductible. The amount you pay upfront, typically over multiple appointments, before your insurance plan starts covering 100 percent of expenses.
  2. Co-payments. DHMOs often require a co-pay, a fixed cost you pay to your provider at the time of your appointment.
  3. Co-insurance. PPOs and indemnity plans may have a co-insurance charge, a percentage of the cost of the treatment you need to pay.
  4. Premium. A premium is a monthly amount you pay your insurance provider for coverage. Usually, the more you pay out of pocket for care, the less you pay as a premium.
  5. Annual maximum. Many plans have a maximum coverage amount and won't pay for treatments exceeding that amount within a given year.

How Dental Insurance Works

Dental insurance is available in many forms, such as group plans for employees through their employer, family plans intended to cover multiple people, and individual plans. Depending on the plan, the insurance benefits will wholly or partially cover dental treatments and services.

Choosing Dental Insurance

You can find dental insurance plans easily online. Employer-provided programs typically have cheaper monthly premiums, better co-pays, and other benefits.

As you compare individual plans, here are some questions to consider:

  • Is your current dentist in-network, or will you have to switch dentists?
  • What are the costs associated with this plan, such as deductibles, co-payments, and co-insurance?
  • Is the monthly premium affordable?
  • How much coverage does each plan provide?
  • What treatments are covered, and what percentage are they covered?

Dental Insurance for Students

Dental insurance coverage depends on the terms of the plan. Many basic dental insurance policies include yearly or bi-yearly examinations, x-rays, dental hygiene treatment, fillings, root canals, and preventive care such as dental sealants and fluoride therapy. Other plans may cover special treatments like crowns or braces. Young people, such as college students, often only use their coverage for preventive care, so students can keep their teeth strong and healthy and avoid needing more serious dental care.

How to Make the Most of Your Dental Insurance Plan

Although you might think dental insurance is only needed for extensive dental procedures, taking advantage of all preventive and cosmetic dental work benefits is a great idea. Keeping your preventative care appointments twice a year is typically affordable. It ensures that oral health problems are prevented and treated early, saving you time and money.

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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