Types of Dental Coverage: Which Is Right for You?

In the United States, 77 percent of the population has some form of dental benefits, reports the National Association of Dental Plans (NADP). Some people get their dental coverage from public programs like Medicaid and Medicare, while others receive private coverage through their employer or another organization. If you're one of the millions of Americans who doesn't have dental insurance coverage, you may think getting insurance is out of reach. Fortunately, that's not the case. There are many types of dental insurance coverage you could obtain; it's just a matter of deciding which type is best for your situation.


Dental Health Maintenance Organization (HMO) Plans

Dental HMO plans are the first type to consider. These plans are sometimes called pre-paid plans. Members are assigned to a dentist, and every month, the dentist receives a set fee per member. These fees allow the members to receive contracted services at either no cost or low cost, explains the American Dental Association (ADA).

Dental HMOs are an affordable dental insurance option. Since routine services are provided at no cost or at reduced cost, dental expenses are easier to budget. This benefit comes with some trade-offs. You typically have to get treatment at your assigned dentist's office to get a benefit, says the ADA. If you see a different dentist, you may have to pay the full price.


Dental Preferred Provider Organization (PPO) Plans

Dental PPOs are the most common dental policy. The NADP reports that 82 percent of dental policies are dental PPOs. With these plans, a network of dentists agrees to provide care at a discounted rate to patients. When you see an in-network dentist, the plan pays the discounted rate directly to the dentist, and you may have a copay or a deductible. When you see an out-of-network dentist, the benefit you receive is reduced.

These plans help you save money, and they provide more choice than dental HMOs since you can see any dentist within the network. Like other dental plans, they have a total maximum benefit. If you reach the maximum benefit, you'll have to pay out-of-pocket for any additional treatments you want or need. Some services may be excluded, which can vary from one plan to another. For example, braces for adults may be categorized as cosmetic and not covered.


Dental Indemnity Plans

These plans are traditional, fee-for-service plans. These plans usually have a deductible, which is the amount you need to pay out-of-pocket before the insurance plan kicks in. After you meet your deductible, the plan will pay a percentage of the fees for your dental treatments. It's typical for the plan to pay 80 percent of the cost while you pay the other 20 percent, explains the American Association of Endodontists. However, the exact percentage will vary from one plan to another, so always read the fine print.

These plans don't generally provide a network of dentists, so you're allowed to choose any dentist you like. This provides much more freedom than other types of dental plans. With indemnity plans, you may need to pay your dentist at the time of service, and then submit a claim to your insurer for reimbursement. Some dentists will file a claim directly with your insurer and just bill you for the copay, which can ease the strain on your finances.

Many dental insurance plans are available to patients, and there are pros and cons to all of them. Take the time to consider each type of dental coverage so you can choose the best plan for you and your family's needs.


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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Common Conditions During ADULTHOOD

As we get older, dental care for adults is crucial. Here are a few of the conditions to be aware of:

Gum disease – if your home care routine of brushing and flossing has slipped and you have skipped your regular dental cleanings, bacterial plaque and tartar can build up on your teeth. The plaque and tartar, if left untreated, may eventually cause irreparable damage to your jawbone and support structures, and could lead to tooth loss.

Oral cancer – according to the National Institute of Dental and Craniofacial Research, men over the age of 40 have the greatest risk for oral cancer. About approximately 43,000 people will be diagnosed with cancer of the mouth, tongue or throat area, and the ACS estimates that about 7,000 people will die from these cancers. The use of tobacco products and alcohol increases the risk of oral cancer. Most oral cancers are first diagnosed by the dentist during a routine checkup.

Dental fillings break down – fillings have a life expectancy of eight to 10 years. However, they can last 20 years or longer. When the fillings in your mouth start to break down, food and bacteria can get underneath them and can cause decay deep in the tooth.