Most Exchange health plans, including dental, can only be purchased or changed once a year during a short window of time called the open enrollment period.
For the 2018 plan year, open enrollment begins in November 1 and ends on January 15, 2018.
There are few exceptions to purchasing healthcare coverage outside of the open enrollment period. They are referred to as qualifying life events. Qualified life events included getting married or divorced, having or adopting a child, or losing your job or starting a new one. If you experience one of these qualifying life events, you are eligible for a special enrollment period.
Whether you’re purchasing an individual or family dental plan through open enrollment or a special enrollment period, there are some things you should consider.
7 things to look for when enrolling in a new plan:
Monthly premium is the amount you pay to the carrier every month for your dental coverage. Different plans have different premiums. It’s wise to select a plan that meets your dental needs and fits your budget.
Covered treatments and procedures
Dental plans are unique. They’re all designed to meet specific dental needs. It’s important to look closely at what’s covered by your plan. If you’re relatively healthy and don’t expect to need more than cleanings, a prevention-only plan may be a good fit for you. However, if you anticipate needing fillings or crowns, you want to purchase a dental plan that offers coverage for these services.
Some dental plans, like medical plans, have deductibles. A deductible is the amount you pay before your dental benefits kick in. It’s kind of like the buy in at a poker game. Dental plan deductibles can range from $0 to $85 individuals.
Coinsurance is cost-sharing between you and your dental carrier after your deductible has been met for the plan year. For example, let’s say you need a crown and have a $50 deductible. Crowns are Class III procedures and your plan covers Class III procedures at 50%. Your dentist says your crown will cost $1,000. You pay your dentist your $50 deductible. The remaining $950 is split between you and your dental carrier. So, you pay your dentist $525 and your plan pays them $475.
An annual maximum is the maximum amount your dental plan will pay towards your care during the plan year. Some plans exclude preventive and diagnostic, or Class I, procedures from accruing towards your annual maximum. That means any amount your plan pays for cleanings or exams isn’t taken out of your annual maximum.
For the plans we offer on the Washington Health Benefits Exchange, annual maximums do not apply to pediatric coverage (children under age 19) and all have an out-of-pocket maximum of $350 per child and $700 for 2+ children.
The out-of-pocket maximum is the most you could pay during the coverage year for your share of the cost of covered services. This limit helps you plan for dental care expenses.
Dental plan network
There are many different types of plans, but the majority of dental plans sold on health exchanges come with access to a Preferred Provider Network (PPO) or a Dental Health Maintenance Organization (DHMO).
PPO dentists contract with dental carriers to provide services at discounted rates and submit claims forms for you. PPO plans often provide the greatest access to care.
DHMO plans come with set fees for services, but limited access to care. DHMOs require you to visit one of their clinics to receive dental care.
We recommend you consider all of these plan features when purchasing your 2018 dental coverage on the Washington Health Benefit Exchange. Every smile, and dental plan, is unique. It's important to find the plan that best meets your oral health needs.
Want more tips?
Review our Dental benefits explained guide for more information about dental plans.
Learn more about the Delta Dental - Individual and FamilySM dental plans we offer on the Washington Health Benefits Exchange. Then, use our Find a Dentist tool to see if your dentist is a Delta Dental network provider.