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Dentures, braces and dental emergencies like broken or impacted teeth, in addition to basic oral health maintenance (e.g., check-ups and cleanings), can be extremely costly for middle and low income individuals, which makes having a good dental insurance policy extremely important. The self-employed and/or those who work for employers that do not offer dental insurance may feel that finding an affordable individual dental insurance plan that covers most if not all of the aforementioned dental issues is next to impossible. There are, however, a number of reputable insurance companies that offer their clients budget-friendly coverage. The purpose of this article is to help point you in the right direction by explaining what you should look for.

What is the difference between individual and group dental insurance?

As the name suggests, individual dental insurance provides dental coverage for one person. Unfortunately, as health and dental insurance premiums offered through group insurance policies continue to rise, it appears as if some employers are attempting to cushion the blow by shifting the cost to employees. And while group insurance premiums are usually less expensive than individual dental insurance policies, there are some well-known and lesser known insurance companies such as Aetna, Blue Cross and Avia that offer budget-friendly individual dental insurance plans.

What kind of coverage should I choose?

Only you can answer that question. To help guide you in the right direction, ask yourself the following question: Do I want to pick my own dentist? If you answered yes, then you will more than likely want to select what is known as an indemnity dental insurance plan. While this particular dental plan offers the most freedom, one drawback is the high deductable. If you have no preference, then selecting a dentist through your dental insurance company’s Preferred Provider Organization (PPO) may be a better choice. One of the many perks a PPO offers is that you can select a dentist outside of the PPO, as you would with a dental indemnity plan, if you want to. However, PPO plans are usually less expensive than dental indemnity insurance plans. Another thing to consider is that it is usually more cost effective to select a dentist within the PPO network. Another popular dental insurance plan is known as the Dental Health Maintenance Organization (DHMO or HMO). While DHMO/HMO plans are usually more budget-friendly than dental indemnity and PPO plans, the policies are more limiting.

How do I find a dentist?

The American Dental Association (ADA) has a wealth of information that can be reviewed online athttp://www.ada.org. You can learn about a dentist’s credentials and narrow down your choices by specialization and/or location.

Where can I find out about individual dental insurance plans?

There are a number of websites that provide information about dental plans such as nadp.org and dentalplans.com that will help you find both dental plans and dentists based on your location and budget.

The bottom line

As with any policy, it is of paramount importance that you spend some time reviewing plans. Read the fine print, make phone calls and send email to the dental insurance companies you’re interested in until all your questions are answered. By doing so, you will know what to expect the next time you need to make a trip to the dentist’s office.

How to Choose an Individual Dental Insurance Plan

Good dental health is a vital part of overall wellness, and dentists are important members of your health care team. Along with helping their patients maintain an attractive smile and strong teeth, oral health care professionals can help prevent and detect serious illnesses such as cancer, diabetes and cardiovascular disease.

Having a dental insurance plan helps make quality dental care affordable, and protect you from unexpected expenses like emergency dental services. There are a wide variety of options available in individual dental insurance, ranging from basic emergency coverage plans to policies that cover both preventative and restorative services. Due to the increasing number of freelance workers, independent contractors and entrepreneurs who are not covered under group insurance plans, dental insurance companies are now offering many different plans to address the coverage needs of uninsured individuals.

When considering a dental insurance plan, it is helpful to decide the premium you can afford. Typically, dental insurance plan premiums are paid monthly, although some providers do offer plans that are include annual premiums. These payments can usually be made using pre-authorized payment through your checking account.

Some questions to consider when choosing a dental insurance plan are:

Does the insurance company pay the dentist directly, or are patients required to make up-front payments to the dentist and submit for reimbursement from the dental insurance plan provider?

What is the annual deductible, and when does it reset each year?

Which services are excluded from the plan? Are there waiting periods for new plan participants?

Are dentists available in your area that belong to the plan you are considering?

Can patients see out-of-network dentists, and if so, what fees are involved?

Does the insurance company have a good reputation among existing patients and dentists?

Dental insurance plan coverage may exclude services such as orthodontics, teeth whitening and dental implants. Before deciding on an insurer, be sure that you have a clear understanding of all the exclusions and optional benefits. The types of services covered can vary significantly between insurance providers, and even among different plans and option packages from a company.

If you already have a dentist that you are comfortable with, consider asking your dentist to recommend a dental insurance plan that he or she belongs to. This is a great way to find a plan that both fits your needs and will allow you to continue as a patient with your current dentist. Also think about having a complete dental checkup before choosing a dental insurance plan, as this will help you predict the types of services you are likely to need in the next few years.

Most dental procedures fall under one of three categories. These include major, preventative and basic (also known as restorative). Coverage under a dental insurance plan often designates a set amount or percentage of payment for each procedure category, and the service categories may vary between insurers. Before purchasing a dental insurance plan, consider what types of dental services you are likely to need in the future, as this will help you select the best insurance for your particular dental care requirements.

Dental Insurance Coverage

The most important part of purchasing a dental plan is understanding the dental insurance coverage of the plans. Some plans cover a certain percentage of a procedure (e.g. 80% of the cost of a filling) while others require a set co-pay regardless of what your dentist charges for the procedure. Some cover a certain number of procedures each year. If your dental insurance plan has an annual deductible, that number represents the amount you will pay out of pocket per year before the coverage begins. For example if your deductible is $20, and you get two $100 cleanings per year, for the first cleaning you would pay $20 and dental insurance coverage takes care of the rest. For the second cleaning and any work done after that, you would only have the co-pay if applicable. Check how long it will take for coverage to kick in, and whether your plan will be handled by the dentist and insurer, or whether you will be responsible for submitting all paperwork. Some dental plans work as reimbursement for procedures, which means that the patient must be able to pay at the time the work is done. Dental insurance for adults coverage usually extends to cleanings, fillings, extractions, root canals, periodontic services, crowns, bridges, oral surgery, and dentures. If you are buying for a child, make sure to get a plan which also covers orthodontics. No matter who you insure, be certain of what the plan does and does not cover before signing up.

Dental insurance coverage can mean many things, but in general when you purchase a plan, what will happen is that the cost of dental procedures from then on will be greatly reduced. Some plans have a maximum that you can spend per year. Those dental insurance plans are usually cheaper than the unlimited plans. These plans are good for a customer who doesn’t have any history of dental problems and would not expect to spend more than the maximum anyway. When buying for a young adult it is wise to consider that just because dental problems have yet to erupt does not mean that they will never come. Your dentist’s office will help you to keep track of how much you’ve spent on your current plan, and most offices are happy to suggest treatment routes which stay within a budget. Most plans have a list of covered care providers by region, so make sure to choose a plan of dental insurance coverage which works in your area. If you choose to continue seeing a non-covered care provider, your plan may only partly cover the costs, or may not work at all. If you travel a lot, you may need your dental insurance coverage to be flexible enough to be used in an emergency away from home. If you’ve had major dental issues in the past, you may need to see a specialist and not just a regular dentist, so make sure to buy a plan which covers that option.

There are many factors to consider when buying dental insurance coverage; however the three main considerations are how much you will use the plan, the types of procedures that may be needed, and which dentists are covered under the plan. If you are determined to stick with a favorite dentist, choices may be more limited. If you know that you will use the plan a lot, it is best to pay a higher price for unlimited care. Check into which procedures, how many, and when you begin receiving service after signing up. Often times, the cheapest plan is not the best option, especially if it means that you end up paying out of pocket later. Carefully choosing dental insurance coverage which fits your history and lifestyle means receiving the best treatment at the best price.

Anyone who has suffered through the pain of an untreated cavity, where every bite sends shockwaves of pain through the jaw and mouth, understands the need for quality dental insurance plans. Untreated infections in the mouth, teeth and gums do not simply go away if left alone. The body does not naturally fix a cavity or gum disease. To further the urgency of proper dental treatment, recent research points to a connection between heart disease and gum disease (gingivitis), so bad gums might mean quite a few more problems than simple pain or cosmetic issues. There are multiple types of dental insurance plans an individual can choose from, with the current insurance market offering every customer the chance to choose a plan based upon not only their dental needs, but also economic concerns.

While choosing between all the different dental insurance plans can be difficult, an indemnity plan might appeal to a customer looking for greater freedom of choice. Like many other insurance plans, the customer pays a premium and the insurance company covers a certain percentage of the cost of dental procedures. Indemnity plans offer the customer the freedom to choose any dentist they want, an opportunity many customers find desirable. Along with this freedom comes the requirement that all procedures follow the Usual, Customary and Reasonable (UCR) pricing standard the insurance company established. This standard states that the dentist must charge an amount the insurance company deems reasonable for the specific procedure or the insurance company will base the coverage percentage upon their UCR standard. For example, suppose a customer receives 80 percent coverage for teeth cleaning. If a dentist charges $100 for the cleaning and the insurance company believes $80 is the reasonable cost, the insurance company will cover $64 dollars of the cost of the treatment, rather than $80, leaving the customer with an extra $16 cost.

Other dental insurance plans also offer the freedom of choosing your own dentist. One type of plan is a preferred provider organization plan (PPO). With a PPO, the insurance company maintains a list of acceptable dentists, who work independently of the insurance company. The network of covered dentists is regularly very diverse. While this type of plan doesn’t allow the absolute freedom of an indemnity plan, it allows the customer the opportunity to choose from a wider range of dentists than a HMO plan does. If a customer is traveling and needs to visit an out of network dentist, most PPOs allow the customer to pay an extra fee for treatment. PPOs also offer lower deductibles than most other plans.

Dental insurance plans can also offer the type of benefits found in a health maintenance organization (HMO) plan. Operating very much like the medical HMO plans, dental HMOs maintain a network of doctors who work under the umbrella of the organization. One of the major benefits of a HMO is that many of the less complicated procedures are provided free of charge, other than the regular premium payments. The drawback to this is the network of dentists is normally smaller than in other plans. Customers are also normally not allowed to visit an out-of-network dentist, and will not receive any coverage at such a dentist.

Keeping those pearly whites in good working order can be an expensive endeavor. Luckily, individuals can purchase dental benefits insurance to help cover the cost of routine cleanings and X-rays and keep more extensive dental work from breaking the bank.

Dental benefits insurance can use a health maintenance organization, a HMO, or a preferred provider organization, a PPO. HMO plans require participants to choose one dentist to use as their primary dentist. This provider would take care of routine dental work and determine if care by a specialist, such as an orthodontist or periodontal surgeon, is needed and refer the participant to a specialist in the dental network of providers. In a PPO plan, participants can choose any dentist they would like for service, but benefits will be less if a selected dentist is not part of the provider network. Both HMO and PPO plans offer savings on dental fees for routine check-ups and cleanings.

Another type of dental benefits insurance is indemnity insurance. With this type of coverage, participants must pay a portion of the dental care costs out of pocket. With benefits only covering 20 to 50 percent of all dental care costs, including preventative, this plan is likely to be beneficial only for those with minimal coverage requirements.

Many dental benefits insurance plans have a deductible that must be met before some benefits are covered. There is also often a maximum benefit amount for each calendar year. Often, diagnostic and preventive care will be covered 100 percent with no annual deductible. This can include two dental exams and cleanings a calendar year, which is the recommended amount, as well as fluoride treatments and space maintainers for children. Periodic full mouth and bitewing x-rays are also considered diagnostic tools and can help prevent more costly dental care in the future which therefore covered at 100 percent.

Dental benefits insurance will often pay only a percentage of the cost for dental services. Coverage for fillings, simple tooth extractions or emergency treatment for pain may only be covered at 80 percent by the plan after the yearly deductible has been met.

Expensive dental procedures, such as root canals or oral surgery to remove impacted teeth, may be covered at only 50 percent. The plan may also cover only a portion of supplemental or prosthetic procedures and equipment, such as crowns, bridgework and dentures.

Those needing orthodontic coverage will want to check the plan specifics closely. The plan may have special deductibles and lifetime benefit caps and may even restrict orthodontic coverage to children. Often, if orthodontia is covered, participants will need to locate an in-network provider to receive maximum coverage. Be sure to check the provider list before signing up for coverage to make sure a provider is conveniently located.

Some dental benefits insurance plans may require dentists to pre-certify any procedure estimated to cost more than a set amount. The insurance company would then decide if it will pay for the treatment recommended by the provider or require a lower cost treatment option. This requirement can delay treatment while the company determines coverage eligibility. Some plans may also exclude higher levels of dental work during the first year of coverage.

Before selecting a dental benefits insurance plan, consumers should carefully examine their dental care costs from the past several years and determine what type of plan will best provide for dental care in the coming years. Those needing little care may find an indemnity plan adequate and affordable. However, HMO and PPO plans can ensure preventative care is provided on a regular basis, often making more extensive, and expensive, dental work unnecessary.

Delta Dental Plans Association is a not-for-profit organization offering national dental coverage through its 39 independent member companies. Although the umbrella organization of Delta Dental is not-for-profit, some of the member companies are for-profit. Formed in 1966, Delta Dental is the oldest company to specialize in dental coverage. Delta Dental operates in all 50 states plus the District of Columbia and Puerto Rico, providing coverage to more than 54 million people.

Since Delta Dental is composed of independent member companies, prospective customers will need to purchase coverage from their local member company. Although group coverage is offered nationwide, individual coverage is only provided in certain states, although the majority of states have a provider offering individual or family dental coverage. An individual looking to purchase coverage from a Delta Dental member company can locate their state’s provider on the Delta Dental website.

Delta Dental offers a variety of coverage options, dependent upon the state and member company. Member companies can offer both HMO and PPO plans, along with indemnity plans for low-income individuals and families, although these plans are limited offerings and currently restricted to only a few states. Since the majority of Delta Dental plans are employer purchased group plans, some member companies also offer continuation coverage for employees who lose their group plan dental coverage. As with any of the individual plans, prospective customers will need to check with their local provider for assistance with enrolling.

While plan details will differ with the individual member company, Delta Dental in general offers customers the opportunity to choose from a network of dentists who are contracted with Delta Dental. Since Delta Dental is such a large provider, the list will normally be large enough to provide most any patient with a conveniently located dentist.

Under the PPO plans Delta offers, there are different levels of coverage, but the plans operate by and large like a regular PPO plan. The patient gets to choose their dentist from a list. Each dentist has agreed to a set level of fees for each type of procedure, never exceeding the agreed upon level of fees. Delta Dental then covers a certain percentage of each type of procedure, depending upon the plan. Waiting periods for certain procedures can also vary, with some of the more intensive procedures requiring longer waiting periods. Some member companies also offer the Delta Dental PPO Plus Premier plan which allows the patient to see a participating dentist outside of the normal PPO network at the same price as a dentist inside the PPO network.

Delta Dental’s HMO plan, called DeltaCare USA, follows the normal HMO pattern. Each dentist is paid a set salary each month while overseeing the patient’s primary dental needs and referring the patient to a specialist if necessary. Co-payments are kept to a minimum, some plans offer zero co-pay options, and billing is always handled by the dentist. Many of the more routine procedures can be free of charge for the patient. This plan’s stated emphasis is preventive care. One downside of a HMO plan can be the shorter list of dentists which a patient can choose from, since many dentists choose to enroll in the PPO network.