Dental Plan Coverage


September 5, 2017

One of the most popular ancillary coverages offered by health insurance companies, and one that is the most requested by employees, is dental insurance. At the end of 2016, about 66 percent of Americans had dental benefits. However, there are many different dental plans, each with its own set of pros and cons. Before choosing a dental plan, it’s important to understand the different terminology and the benefits and drawbacks of the most popular plans.

Different Coverages

Dental insurance varies widely among plans. Most plans can be described as 100-80-50 coverage. This means that routine preventive and diagnostic care is covered 100 percent (you’ll pay nothing out of pocket). Fillings, root canals and other basic procedures are paid at 80 percent, so you may have to pay a portion of the costs out of your own pocket. Crowns, bridges and major procedures are covered at 50 percent, requiring you to pay a larger amount yourself. The average cost for dental insurance is $350 per year, which is significantly lower than you would pay for dental services if you had no insurance.

Types of Plans

Dental insurance is available in three different plan types. These include:

  • Health Maintenance Organization (DHMO): This plan type restricts coverage to dental professionals in a specific network
  • Preferred Provider Organization (DPPO): With this plan type, you can see dentists outside the preferred network, but providers inside the network cost less
  • Indemnity: With this type, you can see any dentist but are often required to pay a percentage of the costs

Discount Dental Plans

There are dental plans known as discount dental plans or dental savings plans. However, these plans are not actually insurance. Instead, a group of dental providers agrees to accept discounted fees for members of the plan. The discounted rate is paid directly to the dental provider rather than paying premiums to an insurance company. These plans have no deductible, no co-pays and no claim forms to fill out. Some dental insurance companies have waiting periods before services start, but discount dental plans do not have any waiting periods. If you live in a rural area, however, a discount dental plan may not be the best option as the plans are not available in all areas of the country.

Drawbacks of Dental Coverage

There are some drawbacks to dental coverage, however. Plans can cost as much as $500 per year and most dental plans have a cap that can be as low as $1,000. Premiums vary depending on where you live but are not based on age, which can be a problem for some senior citizens. Most require that you pay as much as 20 percent for basic procedures, like fillings, and 50 percent for extensive services, like crowns or bridges. Although two cleanings per year are usually covered and do not count toward the limit, higher-cost procedures, such as dental implants, aren’t usually covered. There can also be waiting periods of as much as 18 months before you are covered for anything but a basic examination.

Despite its drawbacks, dental insurance can save you a considerable amount of money, especially if you have issues with your teeth, mouth or gums. Preventive oral care can help you avoid major problems later. It’s important to review all your options before choosing a dental plan to be sure you and your family are properly covered.