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Dental insurance helps cover the cost of treatments related to the teeth and gums, which in turn helps you maintain a healthy smile. Similar to health insurance, you may have deductibles, co-pays, and coinsurance, and typically, annual coverage maximums — but costs vary from plan to plan.
An estimated 74 million Americans don’t have dental insurance coverage, but finding a plan that works for you is easier and more affordable than you think! In fact, the average Delta Dental plan premium ranges from $30-$60 a month – much less than what the average American spends on coffee a month*. Benefits of having dental insurance include:
Individual dental insurance is a contract between you and your health benefits carrier. When you enroll in an individual dental plan, you have entered into a contract. This means that you are responsible to pay your premiums and follow the rules of the plan and the carrier — such as Delta Dental of Washington — is responsible to pay your dentist for covered services at agreed upon reimbursement levels.
Dental insurance plans vary so the reimbursement level, or portion that the benefits carrier pays, depends on the plan you choose.
Dental insurance coverage depends on the plan you choose. Unlike medical insurance, dental insurance plans have a relatively small number of coverage categories, so it’s easy to keep track of what dental services are covered and how much your dental insurance plan pays for each service. If you get familiar with a few key terms, dental insurance coverage is also surprisingly transparent.
Preventive care (also called diagnostic services)
These services and treatments can include cleanings, oral exams, x-rays, fluoride, and sealants. They can also include periodontal (gum) maintenance and deep pocket cleanings.
Restorative and major services
These include fillings, crowns, root canals, extractions, oral surgery and specialty treatments for gum and teeth structures (periodontics), insides of teeth (endodontics), artificial removable teeth (prosthodontics), and braces (orthodontics).
These dental services are reimbursed at different rates and your dental plan document should list each of these services individually, along with the percentage of coverage or the flat fee cost. You will be responsible for the remainder of the cost.
Cosmetic dental services, such as teeth whitening or veneers, may not be covered by a dental plan. While some plans do cover orthodontic services, many do not. If you’re interested in having coverage for things like braces to retainers, it’s important to understand the details of the plan you’re shopping for.
Some plans, for example, may cover orthodontic services but may exclude dental coverage for the alignment appliances themselves.
If you’re looking to get dental insurance outside of your place of employment, there are a couple of different ways to buy an individual dental plan. How this works depends on the type of coverage you need and how you purchase your insurance.
Health Benefits Exchange:
Many dental insurance carriers offer plans through a health benefits exchange. Washington State, for example, has the Washington Health Benefit Exchange (WAHBE). These plans are designed to meet the needs of families with varying budgets.
Currently, unless you’re over 65 and qualify for Medicare, dental insurance plans can only be purchased through the exchange along with a medical insurance plan.
A good number of dental insurance carriers also offer standalone insurance plans. These are purchased directly through the insurance carrier. In this case, you can buy a dental plan even if you have no health insurance.
As you shop for coverage, here are a few key terms to further explain dental insurance plans.
Premium: This is the amount you pay each month to be enrolled in a plan. For your plan to remain in effect, you must pay the premium on time.
Deductible: Deductible: The amount of money that you must pay toward the cost of dental treatment before the benefits of the plan go into effect.
Coinsurance: The amount you pay (usually shown as a percentage) toward the cost of your dental treatment after the insurance company has paid their share.
Copay: A flat fee that you pay out-of-pocket for certain dental services. The copay is a predetermined amount and doesn’t change, regardless of how much your dentist charges the insurance company for services.
Annual / Plan-Year Maximum:The total your plan will pay each year for specified dental services.