The Consumer's Guide to Dental Insurance

Dental insurance is available to help individuals and families reduce the overall cost of maintaining proper oral health. Dental insurance is designed to encourage preventative measures since most dental issues are avoidable. 

While dental insurance can help lower the costs of your family’s dental needs, knowing what to look for in dental insurance can be confusing. Let’s take a closer look at what you need to know about choosing a dental plan.

What is Dental Insurance and How is it Helpful?

Dental insurance is used to provide dental care coverage for you and your family. Dental insurance is typically separate from medical insurance.

Dental insurance is designed to help individuals receive regular preventative care. By receiving regular checkups, potential problems can be diagnosed and treated early. This helps lower costs in the long run. 

If treatments are needed, dental insurance can help cover some or all of the cost depending on what is needed. Keep in mind that coverage varies by plan. 

Does Everyone Need Dental Insurance?

While dental insurance is not a requirement, we do recommend that everyone have dental coverage. The Office of Disease Prevention and Health Promotion states that a person’s oral health is “central to a person’s overall health and well-being.” Good oral health is more important than people realize. After all, the mouth is the doorway to the body’s digestive and respiratory tracts. 

Those without dental insurance typically do not seek out preventative measures. Without regular checkups, individuals cannot learn about possible issues until it is already impacting their health. Being reactive rather than proactive increases the overall costs. 

Since dental insurance is structured to encourage routine checkups, it can help patients have good oral health. If dental treatment is needed, it can also help offset added costs. 

Where Can I Get Dental Insurance?

Dental insurance can be employer-provided, government-sponsored, or privately purchased. 

Employer

Obtaining dental insurance through an employer is the most common way to access dental coverage. Whether through your employer or a spouse’s employer, you may have several options to choose from. 

Government-sponsored

Government-sponsored dental insurance is another way to receive dental care. Depending on your situation, you may be able to get dental insurance through the Affordable Care Act, including Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP). Each of these programs has different qualifying factors and what they will cover.

Private 

Private dental insurance plans can cost more. They may also have limited benefits. We encourage you to compare plans to find the best one to meet your needs while staying within your budget.

What Does Dental Insurance Cover?

Regardless of what type of plan you select, you should understand what the policy does and does not cover. Before purchasing dental insurance, review the policy to know if it will meet your needs. Many dental insurance policies use the 100-80-50 rule. 

Preventive Care

Preventive care is typically covered 100 percent under policies. As already mentioned, dental insurance is structured to encourage you and your family to take preventative steps to avoid extensive and costly treatments.

Preventive care includes regular dental checkups every six months to once a year, depending on the policy. During regular checkups, you should expect to have a teeth cleaning and an exam. Once a year, you’ll likely undergo dental x-rays.

Check your policy to see how often it will cover checkups and use it. This will help you avoid more expensive dental procedures in the future.

Basic Restorative Care

Basic restorative care is typically covered at 80 percent. You are responsible for the remaining 20 percent.

These types of services usually include extractions, fillings, and recementing crowns or bridges. Check your policy to see what the insurance will cover. 

Major Restorative Care

Major restorative care is typically covered at 50 percent. You are responsible for the other half. 

Major restorative care may include bridges, crowns, gum disease treatment, implants, and root canals. If you are receiving preventative care, you can help avoid the need for these treatments. If they are needed, it will not be as frequent as basic restorative services.

As with all treatments, the insurance policy will outline what is covered and include your portion of the cost. Review it carefully.

Other Dental Care

Corrective or cosmetic care is typically not covered in standard insurance plans. This means that you are entirely responsible for the cost. It may be possible to find policies that include these types of treatments. Or you may be able to purchase a rider policy—an addendum—that adds these benefits to your basic policy for an additional cost.

Corrective or cosmetic care may include braces, other orthodontia, teeth whitening, or veneers.

Basic Tips for How to Access or Purchase Dental Insurance

Every dental insurance plan comes with an explanation of coverage (EOC). This is legally required. Before deciding on any plan, whether through your employer or private provider, review the policy so you understand the coverage, payment structure, and any limitations. We also encourage you to shop around to find the best option.

We encourage you to think about your and your family’s needs. If you have children who will need braces, look for a policy that includes orthodontia. If you are a senior, look for a policy that provides better coverage for procedures you’ll be more likely to need, such as dentures, tooth replacements, or root canals.

Here are other questions to consider:

• Does the plan allow for some flexibility when choosing a dentist? Is your current dentist in the network? Insurance companies have a directory on their site where you can check who is part of their network. If you have a current dentist, call their office to see if they work with a specific insurance company. If they’re not part of the network, you need to look for a different insurance company or be willing to change dentists.
• What will your out-of-pocket expenses be? You may not be able to predict what dental services you will need in the future. Review the premiums, deductibles, coinsurance, and copayments outlined in the policy. If you need more procedures, take this into consideration to reduce your overall out-of-pocket costs. If you’ve kept up with preventative treatment and just need basics, you may not need as much coverage in a policy. 
• How does the plan handle referrals to specialists? If you need to see a specialist, check to see if you need a referral from your primary care dentist or not. 
• How soon before you can start using coverage? Policies may have a waiting period before you can receive specific services. Preventative care typically has little to no wait time. However, basic care services might not be usable for 3 months. Major care can have the longest wait times. These vary by policy.

• How many services are covered throughout the year? Policies may only cover a specific number of services each year. If you know you’ll need more work done, consider a different policy with more annual coverage.
• How long does the policy need to remain in effect? Most insurance policies require you to maintain your policy for a year. This is done to avoid policyholders who get insurance, have the work completed, and cancel immediately after the procedures are done.

We know that dental insurance may not be an option for everyone. If it is not for you, we encourage you to look into our in house savings program. We offer in-house financing options, this allows you to save money even without insurance. We can work with you to discuss what options are available based on the procedures that you need.

At Grove City Dental, our goal is to exceed your oral health needs. Our team is focused on listening to our patients and providing high-quality, individualized care for each patient. To help you in meeting your budgetary needs, we also offer a variety of financing options. We believe that cost should not be a barrier to good dental care. If you are interested in seeing how we can help you and your family, contact us today.