Dental Insurance For Individuals

What You Need To Know About Individual Dental Insurance

What Is Dental Insurance?

Dental insurance operates similarly to other types of health insurance. Most plans are either a DMO or PPO. A DMO locks you into the company’s network of dentists, while PPOs give you the option to use any dentist. Individuals pay a monthly premium in exchange for coverage for a range of dental services. This coverage typically includes preventive care, such as cleanings and check-ups, as well as restorative treatments like fillings or crowns. Dental insurance often comes with deductibles, co-pays, and annual maximums that limit the amount of coverage available.

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The Basics

Individual dental plans are designed to provide affordable and comprehensive coverage for individuals who do not have access to employer-sponsored dental insurance. These plans offer a range of benefits, including preventive care, basic procedures, and even major treatments.

By utilizing an online comparison shopping tool, individuals can easily compare different dental insurance plans. You can evaluate factors such as coverage options, premiums, deductibles, and network providers. This allows them to make an informed decision based on their specific needs and budget.

Dental Discount Plans VS Dental Insurance

Don’t confuse a “Dental Discount Plan” with Dental Insurance.  Dental Discount plans aren’t insurance policies that are backed by your state department of insurance.  They merely give you the a prenegotiated rate equal to what an insurance company deems the service to be a fair payment.  It won’t pay a portion of dental services or cover anything as a copay.  Let’s look at a simple example.

  • The dentist charges $1800 for a crown
  • A dental discount plan’s contracted rate for those services is $1400. This is what you pay as a member of your discount plan.
  • If you had a dental insurance policy that pays 50% for major services, you would only be responsible for $700

Customizing Your Dental Plan To Fit Your Needs

There are 3 primary categories of a dental insurance plan; Preventive, Basic and Major services.  Choose the plan with level of coverage that best meets your needs.  For example, if your only concerned about preventive care like cleanings, xrays and annual exams, you may want the lowest priced plan from a company.  If you’re concerned about major services like root canals, bridges and implants, you should look for the higher level plans.

Coverage During The Waiting Period

Most individual dental insurance plans won’t pay the full benefit or offer any coverage for major services when you first start your policy commonly referred to as a “Waiting Period.”

The waiting period for major services like bridges, crowns, implants and root canals is usually 12 months.   But, there are a few companies that will waive the waiting period for major services if you’ve had other dental insurance for the last 12 months. The existing dental insurance has to be a separate, stand alone dental plan that you pay for separately from your health insurance.  For example, some Medicare Advantage plans or employer group plans include dental coverage at no additional cost.  Those types of plans won’t meet the qualifications to waive the waiting period.

The dental policy may also require you to provide proof that you’ve canceled the other insurance before they pay the claim.  If you are thinking about keeping both plans, check first to see if the policy coordinates benefits or if they have a replacement requirement.  The company may allow you to keep your existing plan and another may not.

If you don’t have qualifying coverage to waive the waiting period, and you’ll need major dental work done in the the next 12 months, the best alternative is to buy a dental plan that has “no waiting period” for major services.  This usually means the insurance company will cover you for about 20% of major services in the first year and increase it to an average of 50% in the second year.

How Much Coverage Do You Need?

Most dental plans have two to three different levels of coverage to choose from meaning a low, medium and high plan.  A low plan pays on an average of up to $1,000, medium plans pay up to $2,000 and high plans can cover up to $5,000 per person per year.

If you know you have a significant amount of expenses headed your way for dental work, you should buy the highest amount offered.  Not only do you know you’ll save a significant amount of money, you’ll also have a a coushion for an the unexpected dental problem.  Severe pain can come on quickley and may require a root canal.  Root canals can also result in a crown or other prosthetic dental work like a partial or bridge.

Your age can make a differernce too.  Obviously the older you are the more likely you’ll need dental work.  If your fairly young, or looking to cover children, you may be able to get by with a basic policy that covers preventive care including cleanings, x-rays, annual exams, fillings, extractions and floride treatments.

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Individual Dental Insurance PPO and DMO Networks

Find out which dental networks your dentist participates in.  It’s easy to confuse a dental insurance company with a dental network.  Most dental insurers lease a dental network.  In otherwords, they contract with a third party who already has a list of dentists that agreed to the terms of network. There are a few individual dental insurance companies who have there own networks, but more often than not they are dental HMOs which have a more limited number of providers. Remember too that HMOs limit you to the list, while PPOs alow you to use the list or go to any other dentist of your choice. If you’re not married to your current dentist and don’t mind changing dentists, choose the plan you like best and use the network for that plan to get the best coverage.

Best PPO Dental Networks

  • Dentamax
  • Connection
  • Aetna
  • Guardian
  • Principal
  • United Concordia
  • Careington

What To Look For When Purchasing Dental Coverage

  1. Waiting period waiver for Major Services
  2. Coverage for implants and lifetime limits
  3. Annual maximum amount the policy will pay
  4. Replacement policy for existing dental appliances
  5. Orthodontia coverage for children
  6. Exclusions for natural teeth that are missing when the plan begins
  7. Take over benefits from group policies
  8. Provider Networks

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