Dental Insurance FAQ

Dental Insurance FAQ

What is dental insurance?
Are dental plans ACA-compliant?
Who should get dental insurance?
How much does dental insurance cost?
What does dental insurance cover?
How does dental insurance work?
Do I need my dental treatment to be pre-authorized by the insurance company?
Will dental insurance cover services only for in-network providers?
Is there an annual or lifetime maximum limit to the dental insurance policy?
Will my dental insurance benefits be paid to me?
When can you get a dental plan?

What is dental insurance?

This type of supplemental insurance is designed to cover dental care expenses. Dental insurance can be offered as part of a medical insurance policy, or as a stand-alone plan.

A dental insurance plan may be setup as an indemnity plan, a participating provider organization (PPO), or a health maintenance organization (HMO) plan.[1]

Dental insurance can help you pay for costs related to maintaining good oral health, which studies indicate can positively impact your overall health.[2]

Are dental plans ACA-compliant?

No, dental plans are not qualified health plans under the terms of the ACA.

However, the Affordable Care Act (ACA) lists dental coverage as an essential health benefit for children under age 18.[3] This means if you purchase an ACA-compliant health insurance plan, dental coverage must be available for your child as either part of that plan or as a separate dental plan.

You also may use premium tax credits through Healthcare.gov to help pay for pediatric dental insurance premiums if your health insurance policy does not include dental coverage.[4]

The ACA does not consider dental coverage to be an essential health benefit for adults 18 and over, nor require insurers to offer adult dental coverage.[5]

Who should get dental insurance?

Anyone who is interested in having good oral health, and wants to receive covered dental procedures at no-cost or at a reduced cost should consider purchasing a dental insurance policy.

Dental insurance is guaranteed issue, which means that all applicants between the ages of 18 – 99 are accepted regardless of health history.

Learn more about dental insurance for kids and families, and dental coverage for seniors.

How much does dental insurance cost?

Your dental insurance premiums are calculated based on factors such as:

  • The plan structure (indemnity or PPO)
  • The coverage level you select
  • Your age
  • Your location
  • How many people are covered on the plan

Typically, dental insurance has low deductibles and can be an affordable way to help pay for costs related to your oral health. Premiums for individual plans cost around $25 per month (or $300 annually), however, premiums can range from $150 to $600 annually.[6]

Find plan options available to you and compare premium costs and coverages by getting a dental insurance quote. Or call 888-855-6837 to speak with a licensed agent.

What does dental insurance cover?

Dental insurance typically covers four types of care with a 100/80/50 plan payment structure:[7]

Service Typical Payment
Preventive – cleanings and check-ups; fluoride treatments for children 100%
Diagnostic* – bitewing x-rays (every 6 months) full-mouth x-rays (every 3 years) 100%*
Basic – fillings, extractions 80%
Major – root canals, crowns and bridges 50%

* Under some plans, diagnostic services are paid at 80% and subject to a waiting period

Services not typically covered by dental plans include, but are not limited to, cosmetic procedures, orthodontics, implants, dentures, oral care related to a medical condition, prescription medication and analgesia pre-medication. Your plan also will not cover expenses in excess of the plan’s annual maximum benefit.

Remember, you must read any policy you’re considering carefully to understand what is covered and what is excluded. And often, waiting periods apply for procedures that aren’t considered preventive care. The above lists are only examples.

Call 888-855-6837 for more details about available plan options. Or learn more about the costs of common dental procedures and decide if dental insurance could be helpful for you.

How does dental insurance work?

Dental insurance provides a benefit payment for a designated set of covered procedures related to teeth and gums, as outlined in your plan’s Schedule of Benefits. Reviewing your Schedule of Benefits enables you to plan how and when to receive care by showing:

  • What services are covered
  • What your out-of-pocket costs will be
  • Whether benefits vary based on selecting an in-network or out-of-network provider

Depending on the plan you select, your policy may include:

  • Annual maximum – the maximum amount your plan will pay towards covered services in a calendar year
  • Co-pay – a fixed amount you pay each time you visit your dental provider
  • Co-insurance – the portion of each covered service for which you are responsible to pay
  • Deductible – the amount you must pay before the plan provides payment for covered services
  • Waiting period – the amount of time you must wait before your plan will pay for diagnostic, basic and/or major dental procedures. Waiting periods vary by state.

Note that routine preventive services, such as exams and cleanings, may not be subject to your plan’s deductible. Learn more about how dental insurance works.

Do I need my dental treatment to be pre-authorized by the insurance company?

Generally, if you need major services, you can ask your dentist to submit a proposed treatment plan to your insurance company. That can help you determine what your out-of-pocket costs for services will be. If you have additional questions, be sure to contact your insurance company for specific details about your plan benefits.[8]

Will dental insurance cover services only for in-network providers?

A PPO dental plan offers a network of dental providers. If you visit an in-network provider, your out-of-pocket costs are typically lower.[9] That’s because dentists within the network have agreed to a negotiated dollar amount for each covered charge with your insurance company.

Out-of-network dentists may charge fees either higher or lower than the insurance plan allows; excess fees are usually your responsibility to pay.[10]

Typically under an HMO dental plan, you must receive covered services from a contracted network provider for the plan to pay benefits.[11]

Is there an annual or lifetime maximum limit to the dental insurance policy?

Yes. There is an annual maximum benefit amount, which varies based on the plan you select. However, most dental plans’ annual limit does not exceed $2,000 per person, per calendar year.[12]

There is also a lifetime maximum amount for prosthodontics and major dental care services; be sure to check your policy for specific details, which vary depending on the plan you choose.

Will my dental insurance benefits be paid to me?

If you select an indemnity plan, you typically may choose to receive your benefit payments directly, or you may ask your insurer to pay the benefit amount to your dental provider.[13]

When can you get a dental plan?

There is no official enrollment period for dental insurance away from the ACA Exchange, so you may apply for coverage at any time. Coverage typically begins the next day after online enrollment. You may only enroll in a dental plan from the ACA Exchange during the annual open enrollment period (or a special enrollment period, if you qualify) when you enroll in your medical policy.[14]

Independence American Insurance Company and/or Madison National Life Insurance Company, Inc. may underwrite the products referenced on this website. Legal Disclaimers.

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