- How does dental insurance work? What are my costs?
- Can I buy dental insurance without having health insurance?
- Does the Affordable Care Act (ACA) require you to have dental insurance?
- Are there limits to what the insurance will pay?
- Affordable dental care is important to me. Are checkups and cleanings covered?
- Do dental plans cover more serious dental work?
- Are braces or orthodontic care covered?
- What’s the best dental insurance for me? What types are available?
- Can I keep my dentist?
- What’s the difference between in-network and out-of-network care?
- Is there a waiting period for services once I’m covered?
- Isn’t a dental discount plan just cheap dental insurance? What’s the difference?
How does dental insurance work? What are my costs?
If you’ve had health insurance, you’re going to be familiar with how a dental plan works.
- You pay a premium, a certain amount monthly, to buy the plan.
- Your deductible is what you have to pay out-of-pocket for services covered by your plan before the insurance company pays.
- Your plan may include copays, a fixed cost you pay for a certain service, like an X-ray.
- Coinsurance refers to the percentage you pay of covered expenses after you meet your deductible. So if your coinsurance for a filling is 30%, and the cost for that service in-network is $100, you would pay $30 of that. The insurance company would pay for the rest of your covered expenses up to your annual maximum.
Are there limits to what the insurance will pay?
Yes. Dental plans generally come with annual maximums, which is the most the insurance will cover in a given calendar year. Those maximums vary depending on the plan and insurance provider. Golden Rule Dental plans offer plans with maximums that range from $1,000 to $3,000 annually.
$1K-3K
ANNUAL MAX
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Do dental plans cover more serious dental work?
Yes. Most cover dental work like fillings, extractions, and root canals. What services are covered and how much insurance will pay vary greatly by plan. To ensure a plan is the best dental insurance for your situation, be sure to check the details before you buy.
Covered Dental Services
- Fillings
- Extractions
- Root canals
- And more
Can I buy dental insurance without having health insurance?
Yes. It is standalone coverage. You don’t need to have any other kind of health insurance to purchase it.
Does the Affordable Care Act (ACA) require you to have dental insurance?
No. The ACA, also known as Obamacare, doesn’t require anyone to have dental coverage. In other words, you won’t face tax penalties if you don’t have it. The ACA does require that dental insurance be offered to you if you have children, but it doesn’t require you to get that insurance.
Affordable dental care is important to me. Are checkups and cleanings covered?
Yes. Almost all dental plans include coverage for routine exams, cleanings, routine X-rays, the kind of preventive care you need to keep your teeth healthy. Plans differ in whether you pay a copay for these services or they are covered completely without anything out-of-pocket by you, but they will be covered.
In fact, one of the main benefits of having the insurance may be that it gives you the incentive to make regular dental preventive care a habit and to reduce the chances of more serious problems down the road.
Are braces or orthodontic care covered?
It depends. Braces and orthodontic work are covered under some plans, but not most. So, if that’s a primary reason you’re looking for coverage, you’ll want to shop around to find a plan that has that benefit. And you’ll want to read the details of that plan carefully.
What’s the best dental insurance for me? What types are available?
There are three basic types: Dental HMOs, Dental PPOs and Dental Indemnity plans. To find the best one for you and your loved ones, you should consider what your most important deciding factors are (for example, cost, keeping your dentist, flexibility) and look at dental plans that suit your needs.
Key characteristics of the three basic types:
Dental HMOs:
HMO stands for Health Maintenance Organization. If you participate in a Dental HMO, you generally have
- Lower premiums than either a Dental PPO or an Indemnity plan
- No annual maximum to the benefits the plan will pay
- A restricted network of dentists and dental providers
- No benefits for going to out-of-network dentists or providers
- A list of copays (standard costs) you will spend for office visits and specific dental services
Dental PPOs:
PPO stands for Preferred Provider Organization. If you choose a Dental PPO, you can expect
- Higher premiums than a Dental HMO
- An annual maximum to your benefits (often $1,000, but it varies by plan)
- A network of dentists or providers that have agreed to offer discounted services and that you can choose to use to save money
- Some benefits paid to out-of-network dentists or providers you might choose to go to instead
- A list of the percent the insurance company will pay for different dental services. (For example, many Dental PPOs cover 100% of preventive services like exams and cleanings but may pay only 50% for major expenses like crowns or bridges.)
Dental Indemnity plans:
This is traditional fee-for-service insurance, offering the most freedom of choice. You can expect
- Higher premiums than either a Dental HMO or Dental PPO
- An annual maximum to your benefits
- A small deductible you have to meet
- No network of providers, meaning you get the same benefits with any dentist you choose (but also meaning there are no network-negotiated discounts on dental services)
- A list of the percent the insurance company will pay for different dental services, just like with Dental PPOs
Can I keep my dentist?
Short answer: Yes. Long answer: To get the most value out of your dental plan, confirm your dentist is in your plan’s network before you buy. In-network dentists agree to lower rates on their dental services, so you’ll save more by staying in-network.
Is there a waiting period for services once I’m covered?
Oftentimes Yes. Don’t wait until you have a problem to get insured. For your insurance to cover some dental services, you may have to wait. Some plans offer immediate coverage for basic services like fillings or extractions, but a 4- to 6-month wait is common. For more major services, like a crown, your waiting period might be longer, like 12 months.
The best dental insurance plans are a long-term investment in your oral health, not a quick fix to a short-term problem.
What’s the difference between in-network and out-of-network care?
Cost and convenience. You can help make more affordable dental care for yourself by staying in-network. A dentist in-network has agreed to lower rates on services. That means you pay less even before your insurance pays for anything by getting a filling worked on at an in-network dentist than by going to an out-of-network one.
Also, some dental insurance plans don’t pay any benefits to out-of-network dentists at all, or pay less. Check your plan before you buy.
Finally, if you stay in-network, you often won’t have to deal with submitting claims yourself. The dental office and your insurance provider will handle that. If you are out-of-network, you may have to submit your own claims and wait to be reimbursed.1
Save more by
staying in-network
staying in-network
Isn’t a dental discount plan just cheap dental insurance? What’s the difference?
No. The two are not the same.
Dental insurance is a type of health insurance where you pay a premium and after any deductibles or copays, insurance pays for covered dental expenses either in full or partially up to an annual maximum.
Dental discount plans operate more like price clubs. You pay a fee, and you get access to certain discounted rates at select dentists. There’s no payout from the discount plan company to your dental provider.
| Dental Insurance | Discount Plan | |
| Monthly cost | Generally higher than discount plans | Generally lower than dental insurance |
| Monthly cost | A balance between you and the insurance company | You do. You pay the fee for joining and pay for the dental service at the discounted provider rate |
| Rates and providers | In-network providers provide services at discounted rates or by copay. Some plans cover preventive care at no cost. | Select providers provide reduced rates on select services |
| Deductible | Generally yes | No |
| Copay/coinsurance | Sometimes | No |
| Waiting period | Usually not for preventive care; usually for basic or major services | No |
| Annual maximum benefit | Usually yes | No. Since no benefits are paid out, there is no maximum benefit |
Note: Both are generally a better option than paying cash out-of-pocket because both have negotiated lower rates on dental care with the dentists involved in their networks.
1Pays non-network provider benefits based on the network negotiated rate. Non-network dentists can bill a patient for any remaining amount up to the billed charge.
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