Will Health Insurance Pay for Dental Care?

Kevin McTigue
November 10, 2020

Dental care can be expensive, and maintaining good oral health is important for your overall health. This is why dental insurance is a necessity for all adults, and especially children. Many people who are shopping for health insurance for themselves or their family want to know if their plan will cover dental care.

While there are some exceptions, usually health insurance policies do not cover routine dental care, such as checkups, cleanings, or fillings. For these services, purchasing a separate dental insurance plan is necessary. However, health insurance will sometimes cover dental care in circumstances that involve surgery or emergencies.

What Dental Procedures Will My Health Plan Cover?

Health insurance plans will usually only cover dental procedures that affect your overall health, such as:

  • Emergency dental surgery following an incident such as a car accident
  • Removal of impacted wisdom teeth
  • Treatment of jaw disorders or disease

Ultimately, the only way to know for sure if your health insurance plan will cover dental work is to carefully review your policy and speak to your health insurance provider.

What Will a Dedicated Dental Insurance Plan Cover?

Coverage varies between types of dental plans. You can expect a typical dental plan to fully or partially cover:

  • Preventative care, including checkups, cleanings and X-rays
  • Fillings or crowns
  • Some types of oral surgery

A “full coverage” dental plan is more expensive, but will provide more coverage for different types of treatments and procedures, including:

  • Root canals
  • Bridges
  • Implants
  • Basic and major restorative care
  • Orthodontics (in some cases)

Cosmetic dental work is usually not covered in most dental plans.

Which Dental Insurance Plan is Right For Me?

Choosing which health insurance plan is right for you or your family can be overwhelming, and picking the wrong one can end up costing you a lot of money. Deciding not to have health insurance is also a very dangerous course of action that can have a number of bad consequences. The same applies to dental insurance - the plan that is right for you will depend on your budget and your family’s needs. Here are some things to keep in mind when choosing a plan that fits your needs.

Picking Your Marketplace

Many people get health insurance through their employer, in which case they do not need to rely on marketplaces for insurance. However, with the rise of start-ups and gig-based jobs, more and more people are purchasing their own health and dental insurance through either a government marketplace, private exchange, or directly through an insurance company. Investigating which marketplace has the best plans for your needs is well worth the time and effort.

Comparing Plans

When choosing a dental insurance plan, it is important to carefully take stock of you or your family’s dental needs and expenses. While it is impossible to predict what may happen in the future, being mindful of current and past expenses can help you make a decision.

The major types of dental insurance plans are:

DPPO: Dental Preferred Provider Organization - A common and popular type of dental plan that keeps costs low when you go within the network.

DHMO: Dental Health Maintenance Organization - An affordable dental plan with no deductible that usually covers 100% of routine cleaning and exams.

DEPO: Dental Exclusive Provider Organization - Give you the option of going to a general dentist and specialist, but you must see doctors in-network to be covered.

DPOS: Dental Point of Service - Offers the freedom to go in or out of network, but costs will stay lower in network. You will be required to choose a primary care dentist.

Dental Indemnity - Sometimes called a ‘traditional’ dental plan, dental indemnity has no network and gives you the freedom to see whatever dentist you want. Usually has an annual deductible and coinsurance.

Choosing a Network

Going to a dentist in your network costs less because of agreed-upon rates with insurance companies. Going to an out of network dentist can be costly, as your insurance will pay for a lower portion of your services. If you have a preferred dentist you want to continue using, it is important to make sure you pick a network that they are in. If you do not have a preferred dentist, it’s a good idea to pick a large network with lots of options.

Weighing Out-of-Pocket Costs

Every dental insurance plan should clearly detail how much you will have to pay out of pocket, including deductibles, copayments, and coinsurance. Generally speaking, the higher your monthly premium, the lower your out of pocket costs will be.

A “full coverage” dental plan with higher monthly premiums but lower monthly costs may be right for you if:

  • You frequently go to a dentist, specialist, or seek emergency care
  • You or a family member needs orthodontics or dental implants
  • You are planning to have oral surgery in the near future
  • You have a chronic condition that affects your oral health
  • You take expensive medications regularly for dental purposes

On the other hand, it might be better to go with a lower monthly premium and higher out of pocket costs if:

You are generally healthy and do not go to the dentist beyond routine checkups

You cannot afford a higher monthly premium

Checking Additional Benefits

The final step in deciding which dental plan is best for you and your family is to look at any additional benefits that may be offered, including but not limited to:

Are some plans better than others for orthodontics, or any other specialized need?

Is one plan better for a certain medication you take?

By taking the time to research networks, plans, and benefits, you will find a plan that makes the most financial and medical sense for you and your family.

Author Bio: Kevin McTigue is a copywriter for ACI Medical & Dental School in Eatontown, NJ, offering in-demand career training programs, including a medical assistant certification program, dental assistant training program, and medical & dental administrative assistant program.

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