How to choose a dental insurance plan

You never know when a toothache might strike – and if you’ve ever experienced one, you know how important it is to have access to dental care when you need it. Dental insurance is the best way to be prepared for any unexpected problems that might arise. It can save you money in those situations, and, better yet, it will help you prevent more serious problems by allowing you to schedule regular cleanings and check-ups at a much lower cost.

When it comes to selecting a dental insurance plan, there are several factors to consider in order to find a plan that best suits your needs. The details can be confusing: premiums, deductibles, and levels of coverage will vary across plans, so it’s a good idea to thoroughly review your options. Otherwise, you may end up with insufficient coverage in the event of an emergency – or, alternatively, coverage that is more expensive than you budgeted for.

Whether selecting dental insurance through your employer or on your own, the following steps provide general guidance on how to select the right dental insurance plan.

Selecting the Right Dental Insurance Plan: A Step-By-Step Process

Before selecting a dental insurance plan, it’s important to do some homework regarding your family’s and your own dental history, current oral health status, and your budget.

Evaluate Your Needs

If you are a single adult under the age of 30 with very good dental health and no history of oral disease, then your dental insurance needs will be very different than, for instance, a household of four with two young children. The family of four may have one parent with a history of gum disease, a child who is likely to need orthodontic work, and another child with a history of multiple cavities.

In this case, the likelihood for more frequent visits to the dentist’s office and more expensive procedures would indicate that the family of four may want to invest in a more comprehensive dental insurance policy, even if the plan cost is somewhat higher.

To thoroughly understand your requirements, make a generalized list of you or your family’s dental and oral health needs - both historic, current, and predicted - as well as what you’ve paid in the past for dental care visits. This will serve as a good benchmark for evaluating policies and anticipating overall costs.

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Understand the Different Kinds of Dental Plans

There are several different types of dental insurance plans. Each will work differently in terms of out-of-pocket costs, benefits, deductibles, and so on. Generally, dental insurance plans are divided into the following categories:

• Preferred Provider Organizations (PPO): Dental PPO plans are contracted so that members have access to a network of dentists who accept reduced fees for covered services. This means that members are subject to the lowest out-of-pocket costs when receiving treatment from an in-network dentist. The out-of-pocket cost that members do pay is a designated percentage of the reduced fee, called coinsurance. The plan then pays the remainder.

• Dental Health Maintenance Organization (DHMO): A DHMO provides lower cost coverage with a focus on preventive care. Members must use in-network dentists in order to obtain coverage (except in cases that a point of service provision allows them to opt out of the network at a reduced rate of coverage). The dentist network size of an DHMO plan is smaller than that of PPO, but the premium is also much lower, with a higher potential for savings.

• Discount Plans: A discount plan allows members to choose from a panel of participating dentists who charge discounted fees for their services. Members pay these fees directly to the dentist at the time of treatment; no paperwork is necessary. Discount plans typically have a lower premium than PPO and Managed Fee for Service Plans.

• Managed Fee-for-Service Plans: Fee-for-Service Plans, also known as Indemnity or Traditional Plans, will generally offer the largest network of dental providers to choose from. Similar to a PPO plan, members pay a certain percentage for each service provided by an in-network dentist (this portion is called coinsurance) and the plan will pay the remainder. The percentage will vary based on the service received.

Determine Which Plans are Available in Your Area

You may not have access to all types of dental insurance plans listed above – the plans you can choose from will depend on what’s available in your area

Contact the dental insurance companies that serve your region to determine the specific plans available.

Know What’s Covered by Each Plan

Once you have a solid understanding of the types of dental insurance plans available in your area or offered by your employer, you can begin to conduct deeper research into the details – such as covered procedures, waiting periods, and annual limits.

Creating a list of pros and cons can help guide you through the decision-making process. Consider the following questions when evaluating your options:

• What is the annual maximum limit, if any? This refers to the total amount the plan will pay for the benefit period. Is there a waiting period? This refers to the amount of time you must wait after purchasing coverage to be able to access your benefits.

• What are the differences between in-network and out-of-network dental visits in terms of coverage? In other words, are you able to receive coverage, whether full or partial, when visiting an out-of-network dentist?

• If you are hoping to schedule a cosmetic procedure (such as teeth whitening), be aware that most dental plans will not cover these types of procedures. If this is important to you, contact the dental insurance company before making a final decision.

Think About Network Size

Each type of dental insurance plan will have a different sized network (meaning the contracted dentists who are enrolled with the plan) to choose from. If you live in an area where there are relatively few dentists nearby, then network size may be a critical factor.

In addition, you may want to find out whether your current dentist is covered by the plans you’re researching. Be aware that you will likely have to pay more out-of-pocket to continue seeing your existing dentist if he or she is out-of-network.

Consider the Costs and Your Budget

Different dental insurance plans will work differently in terms out of pocket cost. PPO is the most attractive plan because it balances between cost and access to care.

To determine which dental plan makes most sense for your budget, spend some time calculating your estimated yearly dental costs based on historical patterns.

When crunching the numbers, make sure to consider:

• Premiums (monthly vs annual)

• Co-payments

• Deductible (if applicable)

• Annual maximum

This will help you understand your options from a financial perspective and make the choice that best aligns with your family’s budget.

Choosing the right dental insurance plan can be intimidating, but it’s not difficult – so long as you’ve done your homework. Don’t rush into the decision: Instead, take time to evaluate your dental needs, budget, and anticipated level of care. While it’s impossible to perfectly predict every dental injury or illness that may arise, arming yourself with the facts will help you avoid unwanted surprises when it comes to reimbursement and out-of-pocket expenses.

Searching for the right plan? Take a look at our individual dental insurance plans.

Additional Resources

• What’s the Value of Dental Insurance?
• What Does My Dental Insurance Cover?