Finding a good personal dental plan can be as painful as a root canal! If you do a search online, you will encounter dozens of websites that promote numerous dental plans – and it’s difficult to know which plans are good and which ones are not. Most people get confused and decide to go with a carrier with whom they are familiar – but that can be a big mistake. The best carriers for health insurance sometimes offer very weak dental insurance plans. Likewise, some of the best dental plans are offered by smaller, lesser known carriers.
The first consideration is understanding the two main types of dental plans available.
- Dental Discount Plans
- Dental Insurance Plans
Simply put, dental discount plans are NOT insurance. They provide discounts only. Dental discount plans are inexpensive, but there are good reasons for this. I will list the pros and cons of dental discount plans towards the end of this article. For now, let’s take a look at dental insurance…
Is It Really Insurance? Dental insurance plans have annual maximums ranging from $1000 to $3500, so if someone needs two crowns and a root canal, the price could easily exceed $5000. Typically, we think of insurance in terms of protecting us against major financial loss due to very large, unplanned expenses. However, dental (and vision) insurance helps on a much smaller scale.
For some people, dental insurance is not worth the price and they prefer to simply pay as they go – after all, they are not really protecting themselves against major financial loss – which is the case with most other types of insurance, such as health insurance. Going without dental insurance can be a decent approach for those with no history of dental issues and very good oral preventive care. However, I have found that most people without dental coverage do not see their dentist on a regular basis. This allows minor issues (small cavities, receding gums, etc.) to develop into major ones.
Occasionally, I receive calls from people who see a dentist after an extended absence (usually due to a toothache) and learn they have an immediate need for a crown or root canal. I have the unfortunate job of telling people about WAITING PERIODS. There was a plan offered in Georgia and several states recently that offered Dental Plans with No Waiting Periods for Major Services, however, that plan was short-lived. Now, almost all personal (as opposed to group) dental insurance plans make policyholders wait from 6 months to 24 months until they receive full coverage.
A typical plan looks something like this:
Covered Services
Preventive Basic Major Ortho Max Benefit
Year 1 100% 50% 25% 10% $1,200
Year 2 100% 65% 50% 25% $2,500
Year 3 100% 80% 50% 50% $3,500
The plan shown above is the Spirit Dental 3500 plan. Most carriers only offer plans with annual maximum benefits of $1000 to $2500.
It’s important to understand what services are covered under each class: Preventive, Basic, Major and Orthodontia. Typically, the more expensive the service, the less the carrier will pay. Below is a typical breakdown of the services covered under each class:
Preventive: cleanings, check-ups (exams), including x-rays.
Basic: extractions, basic fillings, sealents, and more.
Major: crown, root canals, bridges, endodontic, periodontic, implants, and dentures and more.
There are other important factors to consider, but Waiting Periods is one of the top ones.
- Annual Maximum (limit). One strategy to keep in mind is that if you need dental treatment towards the end of the year and you will likely hit your maximum, it might be possible to stretch out your treatment into the next calendar year, so you have a new annual maximum. Some plans have annual deductibles too, so factor that into your calculations.
- Deductibles: This is the amount you are required to pay before the insurance company pays. Not all plans have deductibles. Some plans have annual deductibles (commonly, the amount is $50); other plans have lifetime deductibles that are higher. The deductible usually applies to basic and major services only, not preventive.
- Cost and Fees: The cost of dental insurance can vary widely, depending on the all the factors listed here. Find out if the plan includes fees. One-time processing fees are understandable since some folks cancel their plans quickly. Be careful the plan doesn’t include an association fee that isn’t included in the premium (and isn’t disclosed until you complete the application).
- Networks: Some plans are indemnity plans, allowing you to choose any dentist. Other plans have PPO networks of various sizes. It’s important to check your provider network to see how large it is. How much more will you pay if you go out of network?
- Orthodontia (ortho): This benefit is usually optional and will cost more. Be careful to read the fine print. Most benefits for orthodontic care are limited. There is a separate annual maximum for this benefit which can be as low as $500 to $1000 lifetime, per family member. Braces are expensive, so check this benefit carefully.
- How benefits are paid. Does the carrier pay based on a Table of Allowances or UCR (Usual, Customary and Reasonable) system? UCR is a fee schedule based on the average retail charges by dentists in certain geographic areas. With a UCR system, carriers will pay a predetermined amount and will require the insured to pay the difference between the UCR and the more expensive charge. This is a common clause found in dental contracts. Table of Allowance is a schedule of benefits that sets dollar limits for services. It’s hard to say which method is better and pays a higher percentage of covered services because UCR calculations are often outdated. Table of Allowance can also be out of date and set very low payment amounts. It is important to ask knowledgeable independent agents which plans are best in this regard.
- Does the plan only pay for the least expensive service? A common “gotcha” is when carriers will only pay for Silver fillings, instead of the more expensive (safer and better looking) amalgam composite fillings.It is also very important to get cost estimates (pre-determinations) when your dentist recommends follow up treatment. Ask your dentist’s office to submit the recommended treatment to the insurance carrier for a breakdown of the costs. This will help you determine how much you can expect to pay out-of-pocket.
Help finding Accepted Dental Plans – Ask your Dentist: It is a good idea to talk your dentist (if you have one) or get recommendations from friends. Talk to the person at the dentist office who handles insurance claims – not just a receptionist who has list of preferred insurance carriers. Find out the plans for which they are considered in-network providers – not just the ones they accept. Make sure they know it’s for an individual plan (if that’s the case). Find out which carriers the like best and why. Sometimes, they prefer carriers that pay them well and timely, not necessarily a carrier that benefits the insured the most.
The Pros and Cons of Dental Discount Plans:
Pros:
- Inexpensive. The cost of these plans in significantly less than dental insurance. The premium can be as low as $10 to $15 per month for an individual.
- No waiting periods. Benefits are payable immediately with most plans.
- No annual maximums.
- Some services, which generally aren’t covered by dental insurance (such as cosmetic), might be covered.
Cons:
- Limited DHMO (Dental HMO) Networks. It can be challenging to find a highly recommended, established dentist. Most established dentists don’t accept dental discount plans, however, there are exceptions. As mentioned above, if you find a good dentist through a friend’s recommendation, find out if they accept any discount plans.
- The benefits are decent, but the savings aren’t substantial – especially on major dental services.
- Payment is required at time of service.
There are some “hybrid” dental plans on the market. Hybrid plans are part insurance (for preventive and basic services) and part discount plan (for major services).
More often than not, people want a recommendation from a knowledgeable, experienced agent. They don’t have the time or desire to compare all the plans and dig into the benefit summaries. So, my recommendations are as follows:
Humana offers a low-cost hybrid plan that is popular among people who don’t have any current serious dental issues. Humana’s dental plan and rate information can be found here.
Other recommended plans:
The Spirit Dental plan referenced above is a very good, but not cheap, dental insurance plan. They offer both indemnity and PPO plans. The only “gotcha” is that basic fillings are considered a “major” rather than “basic” service. Otherwise, this is a solid overall plan that we frequently recommend. The plans can be excellent for folks who want higher annual maximums. Plan and rate information can be found here.
Two more good carriers worth considering are Delta Dental and Renaissance Dental: Click here to see their plan and rate information.
