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A woman smiling in a dentist chair.

The Importance of Dental Insurance and How to Get It

How to Get Dental Insurance

A pretty smile can brighten anyone’s day, but it can also help you live longer. Regular dental exams help achieve and maintain good oral health, reducing the chances of health problems, like endocarditis and heart disease. What’s more, healthy teeth and gums can help prevent complications from chronic conditions, like diabetes. Despite the importance of adequate routine dental services, only 64% of adults see their dentist at least once a year. For people who do not receive regular dental care, dental costs and a lack of dental insurance are significant barriers to seeing a dentist. Read on to learn about how to get dental insurance.

What is Dental Insurance?

Dental insurance — also known as a dental plan or dental coverage — pays for all or part of the cost for dental procedures, like teeth cleaning, fillings and x-rays. Much like health insurance, people who have dental insurance have most of their procedures partially or fully covered, as stated by their specific plan.

Most plans require a copay — an individual’s portion of the payment — in addition to their monthly or annual fees. Having dental insurance makes routine preventative dental care much more affordable and reduces the cost of emergency care and treatments. Unfortunately, not all people understand how important dental insurance is or how to obtain it.

Data from the National Association of Dental Plans show that only 64% (205 million) of the U.S. population are covered under a dental plan, otherwise known as dental insurance.

Of those people who have coverage:

  • 155 million receive their coverage from commercial insurance.
  • 50 million receive their coverage from public insurers like TriCare, Medicaid, or Children’s Health Insurance Program (CHIP).

Types of Dental Insurance

Finding and purchasing a suitable type of dental insurance can be overwhelming. The following includes details on the most common types of dental coverage to help simplify information.

1. Dental Preferred Provider Organization (DPPO)

A DPPO plan utilizes a network of dentists under contract to the applicable insurance company, and these dentists must follow the provisions of the agreement. Some DPPO plans will allow for non-DPPO dentists but with higher fees. Individuals with a preferred dentist may want to check if their dentist is covered under the DPPO plan prior to purchase.

2. Dental Health Maintenance Organizations (DHMO)

With a DHMO plan, reimbursements are only available to dentists who work under the HMO, and treatments are limited to HMO guidelines. The main benefits of an HMO are their affordability because HMO dentists must offer contracted services at low or no-cost to HMO-covered clients.

3. Indemnity Plans

A more traditional insurance plan is the dental indemnity plan. An indemnity plan makes payments for dental insurance claims based on the procedure performed. Clients can choose their dentists freely, though indemnity plans often have a ceiling for coverage.

4. Direct Reimbursement (DR)

Direct reimbursement plans are based on the money spent rather than what type of treatment was provided. After receiving treatment, direct reimbursement clients send a receipt to the insurance company for proof, and the company pays the client for that amount. This insurance is best for people who can afford the upfront costs of care and can wait for reimbursement.

5. Table or Schedule of Allowances Plans

Indemnity plans may pay a set dollar amount for every procedure, regardless of the actual cost. The client is then responsible for making up the difference if there is one. Indemnity plans can also be paired with a PPO.

6. Point of Service Plans

Reimbursement for clients in point-of-service plans is typically higher if doctors and dentists within the plan’s network are utilized and are based on a low table of allowance.

Tips on Obtaining Dental Insurance

In the U.S., people can find information and purchase plans in the Health Insurance Marketplace. In the marketplace, individuals, families and even small businesses can:

  • Enroll in healthcare and dental plans.
  • Receive insurance information.
  • Compare the benefits offered by various insurance providers.
  • Determine eligibility for tax credits for private insurance or government-sponsored programs, like Medicaid.

Many health plans include dental coverage. Stand-alone dental plans can be purchased apart from a health plan, with a separate premium.

When comparing dental plans:

  • Compare affordability and coverage.
  • Check for coverage routine visits, exams and dental cleanings.
  • Check if you are eligible for government health or dental programs or tax credits.
  • Enroll in a dental plan that suits you and your family’s needs.

Questions regarding obtaining dental plans through an employer can be brought up with the company’s Human Resources department or your supervisor.

For Health Insurance Marketplace information, go to HealthCare.gov. Health Insurance Marketplace employees are also available by telephone, all day, seven days a week at:
1-800-318-2596 (TTY: 1-855-889-4325).

Choosing and Applying

Upon finding a suitable dental plan, the applicant fills out an online application. It’s very unlikely that a person will be denied dental insurance, though the insurer can deny future dental claims. Just remember that dental care is a priority, especially for children who have growing teeth. Finding the right plan may take some time, but it may also give you peace of mind.

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