Understanding Dental Insurance: Do You Really Need It?

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If you’ve ever visited the dentist, then you know you’ll leave the clinic with much more than a freshly cleaned set of pearly whites. You’ll also leave with a dental bill, and you already know that most procedures don’t come cheap.

That’s where dental insurance can benefit you.

Not sure if dental insurance is worth it? Below, we cover your basic questions about acquiring dental insurance.

What is Dental Insurance?

Like any insurance plan, dental insurance will help cover the costs of necessary and voluntary procedures. However, your dental plan may be slightly different than your primary health insurance plan. That’s because dental procedures aren’t covered under most health plans, which means you’ll have to purchase a separate policy. Most dental plans will include out-of-pocket costs, including co-payments, co-insurance, and deductibles.

What Can Dental Insurance Cover?

Depending on your insurance policy, you may receive coverage that will pay for 100 percent of preventative procedures, such as cleanings and X-rays; a large portion—usually 80 percent—of basic restorative procedures, such as fillings; and a smaller portion—usually 50 percent—of major restorative procedures, such as crowns. Your insurance may also cover orthodontia procedures.

Coverage limits may apply. This can include limiting coverage to two exams per year or placing a dollar amount on how much your insurance provider will cover within a given year.

This coverage can be for individuals or your entire family. It’s important that you confirm your coverage with your insurance provider, as some insurance plans may cover all types of dental procedures, but others may not cover things like implants or teeth whitening.

What Options Exist?

With dental plans, you generally have three options:


  • Dental Health Maintenance Organization (DHMO): DHMO coverage will cover you if you choose a dentist within a specific network. You may have a co-pay or deductible, but there is usually not an annual dollar amount maximum on coverage. Out-of-pocket costs are usually low if you stay within your network, but it’s common to pay full costs if you visit a dentist outside the network for non-emergency procedures.
  • Dental Preferred Provider Organizations (DPPO): With DPPO, you can choose to work with dentists inside and outside your network. If you choose an out-of-network dentist, your out-of-pocket costs may be higher than that of an in-network dentist, but your insurance will still cover some of the costs. If you go out-of-network, you may have to pay the dentist in full before filing a reimbursement claim with your provider.
  • Dental Indemnity Plan: This type of plan is not bound to a network of dentists, so it allows you to visit any dentist of your choosing, and you don’t need a referral from you primary dentist to see a specialist. You will generally have to pay co-insurance and a deductible, and there is often an annual benefit maximum.


Do You Need Dental Insurance?

While dental insurance is not required by law, it’s a good idea to invest in a policy. According to Bankrate.com, you’re likely to spend around $360 per year on an individual insurance plan. Paying out-of-pocket for two exams, cleanings, and a set of X-rays will run you about $370 per year.

That being said, the out-of-pocket costs and the cost of an insurance plan will be about the same if you don’t need any additional dental procedures. However, having an insurance plan will greatly reduce your costs if you are in need of additional services such as fillings, root canals, crowns, or dentures. On some insurance plans, you may also receive assistance for children’s braces.

Whether or not you undergo an expensive dental procedure, having quality coverage can help you sleep with peace of mind knowing that if you need an emergency or restorative procedure, you can undergo these procedures at a much lower out-of-pocket rate.

What type of insurance plan do you feel best fits your dental needs?


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