Which Dental Insurance Do You Need?

By James O'Neal

If you’ve been to the dentist enough times, you probably have it drilled into your head the importance of flossing and brushing you teeth regularly. You’ve also probably seen all those posters in signs in dentists’ offices that warn against the dangers of gum disease and its correlation to heart disease, cancer, and the like.

Despite these clarion calls for better dental health, however, we all seem to neglect the wellbeing of our teeth and gums. After all, how many of us can really say we floss regularly? Just under half of us, according to a recent survey.

Similarly, we neglect dental health when it comes to insurance. According to U.S. News, around 40% of Americans lacked dental insurance – that’s nearly half of the country!

This number is staggering and it needs to go down. If you need dental insurance, but don’t know where to start, we’re here for you. Below, we’ve broken down all the things you need know when picking dental insurance.

The Types of Dental Coverage

Nearly every dental plan falls under three basic categories. Each one provides varying degrees of coverage and work in a myriad of ways.

Indemnity Dental Insurance Plan

With an indemnity plan, your insurance company pays your dentist or oral surgeon a percentage of the costs for your treatment directly. These plans usually have co-pays, deductibles, annual benefit limitations, or some combination of all three.

It’s basically coinsurance. Your insurer pays some and you pay the rest. The plans are simple and offer the greatest network of dentists.

The downside is that these plans may cover less than you’d want for major procedures. For example, they’d only pay 50% of an expensive root canal surgery and you’d be stuck with the rest. However, they do bring the costs down for preventative procedures like teeth cleanings and general checkups.

Dental Health Maintenance Organization (Dental HMO)

With DHMOs, you are required to choose one dentist or dental office to use for all of your oral treatment. This is because your insurer has already paid a dental office a fee to give its clients a reduced cost. In these plans, you pay a fixed amount of money for a copayment. Oftentimes, preventative procedures like cleanings don’t even require a copayment at all.

Many of these types of plans also have no deductibles or annual maximums for benefits, so you can really get your money’s worth.

The downsides of these plans are that you’re bound to one dental office. Also, if you have something serious come up and you have to see a specialist (e.g. an orthodontist), you may have to speak with your insurer to make sure that they’ll cover the cost, but there is no guarantee.

Dental Participating Provider Network (PPO)

Dental PPO’s strike a balance between DHMO’s and Indemnity plans. Indemnity plans typically give you a higher cost of treat but greater dental options, while DHMO’s reduce cost drastically, but severely limit your choice of doctor.

With PPO’s you can have the some of one, half of the other. When you buy insurance in a PPO, your insurer provides you with a network of dentists to choose from. If you choose a dentist in this network, your insurer will cover a larger percentage of the costs, and you will pay the rest. In this sense, PPO’s work similarly to Indemnity plans, but cover a higher percentage of the cost.

You can also choose a dentist out of your network, and your insurer won’t penalize you as much as they would if you had a DHMO. They’ll just pay a lower percentage of the cost than if you stayed in-network.

The Types of Procedures Dental Insurance Covers

There are 7 types of dentistry:

  • Preventative care (e.g. routine cleanings and office visits)
  • Restorative care (e.g. fillings and crowns)
  • Endodontics (e.g. root canals)
  • Oral surgery (e.g. tooth removal)
  • Orthodontics (e.g. retainers and braces)
  • Periodontics (e.g. root planning, treatment of lesions and infections)
  • Prosthodontics (e.g. dentures)

Insurers then take these seven types of dental procedures and break them down into 3 larger categories.

Preventive Care

As mentioned above, the types of dental work that is covered in this category are routine cleanings, office visits, consultations and things of that nature. Most dental plans cover nearly 100% of the cost for these visits.

Things like x-rays and sealants also fall under this umbrella and are similarly covered by your insurer.

Basic Procedures

Things like fillings, extractions, root canals (occasionally), and light treatment for gum disease fall into this category. These procedures are a step above preventive care in terms of cost and complexity.

Insurers generally cover procedures at a lower percentage (in the case of PPO’s and Indemnity plans) or with a small co-pay (in the case of DHMO’s). Typically, the percentage hovers around 60-80%.

Major Procedures

Big dental procedures like crowns, bridges, dentures, and heavy-duty periodontal work falls under this category. Some procedures, like root canals, can fall under this category or be considered a basic procedure. Make sure to check on this with your prospective insurer before buying a plan. If you’re elderly, you may need a senior health plan that covers these kinds of procedures.

Insurers pay the lowest percentage (usually around 50%) or require you to pay the highest co-payment when covering the cost of these types of procedures.

Which Dental Plan is Right for You?

There is no right answer, but the main factors to consider are cost, coverage, and network.

If having a large network of dentists isn’t a necessity for you, then a DHMO is your best bet. It is especially good if you don’t need any major dental work that requires a specialist and you like to regularly go to dental checkups.

If you want to buy a family plan and your kids are constantly traveling or off at college, then a large network is a necessity. In this case, either a PPO or an Indemnity plan is the best option for you. The same is true if you’re a senior and need some major dental work done.

You just have to evaluate what your needs are and pick accordingly. Please, take a look at the rest of our website if you need more information on insurance or Medicare.