5 Key Considerations When Choosing a Dental Insurance Plan Your Insurance Gal

Going to the dentist can be a stressful experience. however, choosing a dental insurance plan can be just as daunting. In fact, the cost of dentistry is what keeps most Americans out of the dreaded dentist’s chair for years, according to a survey by the American Dental Association.

Reading: How to choose a dental insurance plan

But let’s face it: oral hygiene is essential to our overall health. And while it can be expensive, choosing the right dental insurance plan could save you thousands of dollars in preventive and diagnostic care.

So instead of avoiding the dentist or worrying about what could go wrong, be proactive and research which dental insurance plans will keep your teeth pearly white for less. Here are five key factors to consider when choosing a dental insurance plan:

1. what can you pay?

The most important thing is to choose a dental plan that fits your budget. There are two general types of plans: dental health maintenance organization (hmo) and preferred provider organization (ppo).

hmo plans have lower premiums and no annual deductibles (ie, the excess paid before the insurance company covers a percentage of your claim). instead, you are responsible for the copays listed in your schedule of benefits each time you receive dental services, which correlates to higher out-of-pocket costs if you have extensive dental care needs.

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PPO plans have higher premiums than HMO plans, but they have lower out-of-pocket costs since the insurance company sets a limit on how much in-network dental providers can charge. Under a PPO plan, you must pay an annual deductible, which varies between insurance companies and policies. while ppo plans are more expensive up front, if you have high dental care costs, a ppo plan might be more affordable due to lower copays.

2. Do you have a favorite dentist?

Different plans have different levels of flexibility regarding the dentists and dental providers they will cover. under an hmo plan, you must select and be assigned a primary care dentist within the insurance company’s network and must obtain a referral for procedures. you are free to change your dentist, but only once a month and there may be a long waiting period.

ppo plans are generally more flexible as you have the freedom to visit any dentist in or out of network. however, out-of-network dentists are free to charge their own fee and therefore your out-of-pocket costs may increase. PPO plans are more convenient since you don’t need a referral for procedures and you can change dentists whenever you want with little or no wait time. if you have a preferred dentist, ask what insurance plans and discounts they accept.

3. are you eligible for group coverage?

Most people get dental insurance through their employer or other group coverage plans, like the Affordable Care Act, AARP, or public programs like Medicaid, TriCare, and the Children’s Health Insurance Program.


Group coverage is an attractive option as premiums are generally more affordable than an individual insurance plan and can often provide better benefits. however, it may be worth taking a closer look at the details of group coverage plans, and particularly those offered by employers, to see if the benefits are worth your money.

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4. What are the insurance caps, limits, and waiting periods?

Before purchasing a stand-alone dental insurance plan, whether it’s an hmo or ppo plan, check the details. dental insurance policies have an annual coverage limit that ranges from $1,000 to $1,500 a year. Additionally, most PPO plans require an additional deductible of $50 to $100 to be paid annually.

Dental insurance policies have extensive waiting periods with coverage on specific procedures held for 12 months. You can even wait two years for complicated procedures like dental implants, dentures, and crown or cast restorations. and once you’ve done all that waiting, the benefit can be as little as 50% of the cost. To avoid getting trapped, familiarize yourself with insurance caps, limits, and waiting periods.

5. what does the plan cover?

It can often seem like all insurance plans are the same, but they’re not! While most health insurance plans cover a significant percentage of all medical expenses, even the most extensive ones, dental insurance plans tend to be more fickle depending on the level of coverage. For example, a policy may pay up to 80% or 100% of the cost of routine checkups, cleanings, fillings, and X-rays, but expects you to pay 50% for crowns, root canals, and gum disease treatments.

To budget for your dental expenses, you should carefully review the policy and determine a level of coverage that is right for your needs. each plan will cover these three areas to varying degrees:

  • Preventive and routine care: Regular check-ups, cleanings, x-rays and fillings, fluoride/sealant cavity prevention treatments and types of oral surgery, root canals and gum care.
  • emergency care: treatment after an accident involving the teeth and mouth, such as a missing, cracked, or broken tooth or serious injury to the lips, tongue, or cheeks .
  • complex care: orthodontic treatments (such as braces, jaw alignment), dentures or bridges.
  • choose the right dental plan for you and your family

    A great way to find the perfect plan for you and your family is to visit your dentist and have a diagnostic x-ray exam. Your dentist will be able to tell you about your general dental health and give you a decent indication of any complex procedures that you or your children may need. Hopefully, this will refine your options and make it easier to find the right dental insurance plan.

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