Dental Insurance Carrier: What You Need To Know

Dental insurance is a form of health insurance that helps people pay for dental treatments and procedures. It is usually provided by employers, but can also be purchased as an individual or family policy. Dental insurance covers three areas of dental care: preventive, basic, and major services. Preventive care includes cleanings, exams, and X-rays, while basic services include fillings and non-surgical extractions. Major services cover everything else, such as crowns, dentures, and implants. The cost of dental insurance varies depending on factors such as coverage levels and benefits, but on average, a comprehensive dental insurance plan costs around $47 a month.

Dental insurance providers

Dental insurance is a form of health insurance designed to cover some of the costs associated with dental care. In the US, dental insurance is not provided by the government for all Medicare recipients. Instead, there are several companies that offer dental insurance plans, including:

• Delta Dental: The self-proclaimed nation's leading provider of dental insurance, Delta Dental offers plans for individuals, families, and businesses. They have the largest network of dentists nationwide and provide quick answers and personalized service.
• Guardian Direct: With an extensive network of dentists across the country, Guardian Direct offers comprehensive coverage options at affordable premiums for individuals and families. They provide four levels of Preferred Provider Organization (PPO) plans and have no waiting periods for preventive or routine care.
• Humana Dental: Humana Dental is another provider with a large network of dentists across the country. They offer a variety of Preferred Provider Organization (PPO) plans and the ability to bundle dental and vision coverage. Their plans have no waiting periods for preventive or routine care, and they provide extensive coverage options for Medicare recipients.
• 1Dental: 1Dental offers discount plans, not insurance plans, which provide immediate savings on dental treatments. They have a large network of over 158,000 dental practice locations and offer unlimited use with no annual commitment.
• United Healthcare Dental: United Healthcare Dental offers low-premium rates and a variety of dental plans, including DHMO and PPO plans. They have a nationwide network of more than 85,000 dentists, and their plans provide better coverage after the first year.
• Anthem: Anthem offers stand-alone individual and family dental insurance plans, as well as the option to add dental coverage to their health insurance or vision insurance plans. Their plans cover preventive care, procedures like fillings and crowns, and orthodontics. They have shorter waiting periods than traditional plans and higher annual benefit maximums.

These are just a few examples of dental insurance providers in the US. When choosing a dental insurance plan, it is important to consider factors such as coverage, premiums, annual maximums, and waiting periods.

What does dental insurance cover?

Dental insurance is designed to help you pay for dental care, which can be costly depending on the procedure. It is usually offered as an employment benefit or purchased directly from a dental insurance company.

Dental insurance policies are not one-size-fits-all and vary in what they cover. They range from preventive-only plans to those that help with major care like dentures and implants. Most plans follow the 100-80-50 coverage structure, meaning they cover preventive care at 100%, basic procedures at 80%, and major procedures at 50%. However, it's important to note that not all plans follow this structure, and some procedures may not be covered at all.

Preventive Dental Care

Preventive dental care includes regular exams, cleanings, fluoride rinses, oral cancer screenings, and X-rays. Most dental plans cover preventive care at no additional cost, typically offering two preventive visits per year.

Basic or Restorative Care

Basic or restorative care includes simple procedures to treat cavities, gingivitis, or other oral infections. This can range from fillings and tooth extractions to root canals and crowns. These treatments are typically considered basic care but may be categorized as major restorative care if more complex or extensive work is required.

Major Dental Care

Major dental care involves more complex and invasive procedures that may require anesthesia or oral surgery. This includes endodontics (root canals), periodontics (treatment of structures supporting and surrounding the tooth), prosthodontics (such as dentures and bridges), and oral surgery (such as wisdom tooth removal, tissue biopsy, and minor oral infection drainage).

Orthodontic Care

Orthodontic care focuses on correcting teeth and bite alignment. This includes braces, retainers, aligners, and other devices used to align teeth. Coverage for orthodontic care is more common in plans aimed at children and usually requires an additional fee for adults.

It's important to carefully review the details of any dental insurance plan you're considering, as coverage can vary significantly between plans and insurers. Some plans may have waiting periods before covering certain procedures, and there may be annual maximums or limitations on the number of procedures covered in a given year. Additionally, cosmetic procedures, such as teeth whitening and veneers, are typically not covered by dental insurance.

What doesn't dental insurance cover?

Dental insurance is a policy that covers dental health and care procedures, including preventive, basic, and major treatments. While specific plans vary, there are some treatments that dental insurance typically does not cover.

Dental insurance usually does not cover pre-existing conditions, such as missing teeth. Additionally, some plans may not include coverage for implants, orthodontic care, or adult braces. It is important to carefully review the details of your specific dental insurance plan, as coverage for these treatments can vary.

Preventive, Basic, and Major Treatments

Dental insurance plans often categorize treatments into three tiers: preventive, basic, and major. Preventive care includes routine check-ups, cleanings, and X-rays, which are typically covered at 100%. Basic procedures, such as fillings and simple extractions, are generally covered at 80%. Major restorative or complex procedures, including implants, orthodontics, and periodontal treatment, are usually covered at around 50%.

Choosing a Dental Insurance Plan

When selecting a dental insurance plan, it is essential to consider the coverage, costs, and network of providers. Additionally, pay attention to waiting periods, as some plans may have a delay of several months before covering major procedures. Review the details of each plan to ensure it aligns with your dental health needs and budget.

How much does dental insurance cost?

The cost of dental insurance varies depending on factors such as the type of plan, the provider, and where you live.

The average dental insurance premium in Pennsylvania is $32.18 per month, while in California, premiums for stand-alone dental coverage for adults ranged from $9 to $54 per month in May 2024. In Pennsylvania, stand-alone dental coverage premiums for adults ranged from $4 to $37 per month in May 2024.

Dental insurance plans typically include premiums, copays, coinsurance, deductibles, and annual maximums. The premium is the monthly amount paid for insurance, which can vary between insurance companies and plans, typically ranging from $20 to $50 per month for an individual and $50 to $150 per month for a family.

The copay is the amount paid for a dental treatment or service, after which insurance usually covers the rest of the cost. Many dental insurance plans also require a deductible, which is the amount that must be paid before insurance benefits take effect. The coinsurance determines the percentage of the dental service covered by insurance. For example, if the coinsurance is 90%, the insurance company will pay 90%, and the individual will pay the remaining 10%.

The average dental insurance policy with comprehensive coverage costs $52 a month, while a preventive care plan costs an average of $26 a month. Dental insurance plans typically use a 100-80-50 cost-sharing model, covering 100% of preventative and diagnostic services, 80% of basic dental services, and 50% for major procedures and surgeries.

Overall, the cost of dental insurance varies depending on the specific plan, provider, and location, but it is an essential tool to help offset the costs of dental care, which can be expensive.

How to get dental insurance

A dental insurance carrier is a form of health insurance designed to pay a portion of the costs associated with dental care. In the US, two-thirds of dentists do not accept dental insurance through Medicaid.

Understand the Different Types of Dental Insurance Plans:

• Indemnity Dental Insurance Plan: The insurance company generally pays the dentist a percentage of the cost of services. However, there may be restrictions like co-payment requirements, waiting periods, and annual limitations.
• Dental Health Maintenance Organization (DHMO) Plan: Dentists contract with a dental insurance company, agreeing to accept an insurance fee schedule and offer reduced costs for services as an In-Network Provider. DHMO plans often have no waiting periods or annual maximum benefit limitations and can cover major dental work near the start of the policy period.
• Participating Provider Network (PPO) Plan: Also known as a Preferred Provider Organization, PPOs are governed by medical doctors, hospitals, and other healthcare providers. They offer reduced rates for services from In-Network Providers but also allow the use of Out-of-Network Providers, with any fee differences becoming the patient's responsibility.

Evaluate Your Needs:

Consider whether you need coverage for just yourself, your family, or if you're seeking coverage through an employer. Think about the level of coverage you require, including preventive care, routine cleanings, exams, and more complex procedures.

Shop for Dental Insurance Plans:

You can purchase dental insurance through the Health Insurance Marketplace, directly from insurance providers like Delta Dental and Anthem, or through your employer.

Compare Plans and Costs:

When comparing dental plans, pay attention to details such as monthly premiums, deductibles, copayments, and services covered. Some plans may have waiting periods for certain procedures, annual maximum benefit limits, or specific networks of dentists you can visit.

Enroll in a Dental Insurance Plan:

Once you've found a plan that meets your needs and budget, enroll in the plan by following the provider's instructions. You may be able to enroll at any time of the year, or you might need to wait for the Open Enrollment Period, which typically runs from November 1 to January 15.

By following these steps, you can secure dental insurance that provides the necessary coverage for maintaining your oral health and that of your family.

Frequently asked questions