Everything You Need To Know About Dental Insurance

Dental care is a modern convenience that is also a necessity for hygienic purposes. It can be overwhelming to try and understand what a dental insurance provider will cover. There is definite worry and concern for many being able to have access to all the possible procedures needed to keep your teeth healthy and when things go wrong.

In the Middle Atlantic and East North Central regions of the US, there were lower percentages of unmet dental care needs than the national average because of low cost in the year 2019; 20.6% in the East North Central region, 20% in the middle Atlantic were the statistics showing this trend. In this article, hopefully, you’ll find in-depth information that will help you get an understanding of what an insurance company can and can’t do for you.

What does Dental Insurance Cover

Another statistic shows that in most cases, Americans that do have dental insurance are at a level of about 77%. This shows growth in the industry and is an important service to many. It is important to actually go over what is available to you and start from there. There are different levels of coverage that will work differently for each person. An insurance plan can give you full coverage and protect you from risks and help pay for some of the more complex procedures such as a root canal or other types of invasive procedures.

For example, in a given plan year, there may be an annual maximum that you will reach when getting treatment in a Preferred Provider Organization. In some cases, it could be lower than $1500, which can be a huge issue if you have more than one major procedure to get done in a year. It is important to keep in mind that if dentistry gives too many discounts, it could cause them to lose profits. In this section, the different possible coverage options available will be discussed in depth.

Dental Plan Options

These are the basic starting points of any dental plan. You have four main categories of plans.

Table or Schedule of Allowance Programs: These type of programs works from a determined list of covered services that have a certain price. The patient is charged the difference between the insurance provider and the doctor’s fee.

Usual, customary, and reasonable programs: This category of plan provides more choice in terms of dentists that patients can have, but it also pays partially for the dentist fees by looking at the Reasonable and customary fees and seeing which one is lower.

Direct reimbursement programs: A direct reimbursement program is used to create a predetermined price for the total spent on healthcare.

Capitation programs: These types of programs are often the most accessible to individuals looking for an individual plan. It is a contract that pays a dentist for a fixed amount when they agree to provide certain treatments to patients at no extra charge.

There are also dental plans that provide different levels of coverage that can work within the following types of coverage:

Dental Health Maintenance Organization: A DHMO is similar to a healthcare HMO, but it has the key difference of only working within dentistry. It offers more selection when looking for dentists within a network that can either provide a set copay or no-fee payment at all by the patient. But, the patient can’t look at dentists outside the network.

Preferred Provider Organization: The plan provides a network of dentists that you can choose from, but a key difference here is that you can look for dentists outside of the network for certain procedures, but you will most likely have to pay out-of-pocket. 

Discount/ Referral Plan: This type can work be a part of your health insurance plan. But, it most likely will be outside the health care provider’s system. A referral or discount is an agreed-upon discount that a small group of dentists will offer you.

Best Dental Insurance Providers Based on price and coverage.

When looking at potential health insurance plans and providers, many of the nationwide providers will have a lot more options than some of the regional providers that are located in a certain part of the country. Although, certain regional providers will have good amounts of discounts if you choose plans from these types of providers. In this section, we will discuss national providers and plans offered. Here are some to consider. Most if not all of these insurance providers will be available in all 50 states.

1Dental Pricing Plan Comparison

Expense typeCare500Dental Access
Oral Exam$16$35
Resin Filling (white)$60$101
Dental Cleaning$34$67
Porcelain Crown$526$790
Dentures: Complete Upper and Lower$701$1,003

One of the biggest claims that 1Dental makes is there unconventional approach to insurance. It is less self-described as insurance, and plans that they do provide are sold as what insurance “should look like .” They mainly provide two different dental savings plans. Overall, 1Dental has plans that include no deductibles and offer unlimited use with little to no waiting for appointments. They mainly provide two different dental savings plans.

Spirit Dental Pricing Comparison

Spirit Dental offers two different types of coverage plans, the spirit Dental network plan and the Spirit Dental’s Choice Plan. These tables show possible estimates from quotes, which will vary from patient to patient. They are only meant to be used as an example. If you’re looking for the most affordable, the Network benefits plan is a great option. When you pay the deductible, it will lower the out-of-pocket expense that you pay.

The in-network cost will usually apply to dentists that are with the Spirit Dental Network and can often be a good amount of variety depending on the type of policy you have.

ServiceCost
Retail Cost For Implants$5,000
In-Network Cost$4,000
Insurance Pays$2,000
You Pay$2,000

A Choice Plan is good for a more flexible one because you have the ability to choose any dentist you want. Suppose the dentist is on the network. When paying, you must pay the full cost in order to be reimbursed by Spirit Dental when you submit the expenses paid.

ServiceCost
Implant Cost$4,000
Insurance Covers$1,000
You Pay$3,000

Cigna Dental Pricing and Benefits

Cigna is another long-running insurance provider that has grown into the field of Dental insurance in recent years that has built up its reputation. It has one of the biggest Preferred Provider networks in the US. And has availability nationwide, including Puerto Rico and the US Virgin Islands.

Non-Plan Dental Insurance

Here are some insurance providers that only provide coverage without extensive plans. These are more customizable types of plans. Dental savings plans are a part of the affordable healthcare act that was enacted into the healthcare system in 2008. As an alternative to insurance, there are other options such as payment plans, short-term loans, and going to free events such as ones that dental schools and clinics put on. Although the best treatment is undoubtedly the one you can pay for, and even then, you may be able to get a discount if you are an uninsured patient in some dentist clinics. 

Other Considerations

When doing extensive research, there are key pieces of info you could find before going with a certain provider. Check for emergency treatment coverage and what kind of out-of-pocket expense limits there may be. It is also important to check if your chosen provider and plan has coverage for emergency, preventative and diagnostic services. If you find that you may be paying for two different types of plans, check to see where there is a plan that has overlapping benefits rather than having dual coverage.

With anything worth having and using in life, it requires some education and understanding of terminology. Mainly with deductibles, it is a kind of out-of-pocket expense that is a set amount. The most important terms to know will be shown in this section of this article. You must pay outright first, and then you’ll become eligible to be reimbursed. Another term to understand is coinsurance and more in this section of the article.

Dental Insurance vs. Dental Savings Plans

The first key difference between the two is that a Dental Savings plan is cheaper than dental insurance, which may limit the discounts you can access. With a Dental savings plan, you will have access to an amazing selection of dentists that will, on average, offer up to a 60% discount in some cases. With a Savings plan, you’ll have a short or no waiting time for activation of benefits, which will start working in 72 hours or sooner. You’ll even have multiple discounts for preexisting dental issues and work that is still being done.

Dental Insurance has more of a simplified and streamlined process for getting treatment plans and may not be offered as primary care coverage but will give a better discount for supplemental care and major dental procedures and surgery.

Conclusion

In conclusion, there is a wide and broad spectrum of offerings for dental insurance. It can range from small discounts to help pay for life-changing procedures. Hopefully, this article helped to answer some questions and clear up some information. It is important to continue to research different insurance providers and see what you may be eligible for. The more you understand what dental insurance will cover and what questions to ask, the better you can navigate the world of dental insurance and better understand what it can and cannot do for you.

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