Guide to Dental Plans and Financing
Ah, teeth. The evolutionary tool designed for chewing, biting, displaying nonverbal communication, and most importantly of all — making others smile contagiously and accidentally biting the ever-important tongue whilst chewing. In order to keep those osseous pearly jewels healthy, we often brush, floss, and seek care from our dental practitioners.
In order to do that, you’ll need a dental plan. Before you make that big decision on which plan to choose, it’s important to know a thing or two about it. Continued below is the information you will need to know regarding dental plans.
A Brief History of Dentistry
Believe it or not, dentistry has its roots (just like teeth have roots, let’s keep this just a little entertaining!) in ancient human history. In ancient Sumeria as far back as 5000 BC, there is a record of attention regarding worms being the cause of tooth decay.
In 2600 BC there is an inscription of Hesy-Re, an Egyptian scribe, as being a dental physician. Hippocrates and Aristotle wrote about dentistry and certain treatments for various tooth maladies. By around 200 AD, Etruscans were practicing tooth prosthetics using gold crowns.
By 700 AD, the Chinese had recorded an amalgam similar to the tooth fillings we know now. From 1210-1400 the Guild of Barbers in France was formed, dividing surgeries to one group of barbers, and dental extractions and processes (as well as bodily grooming) to another group. From 1530 to 1575, large advancements were made to the world of dentistry, now a full dedicated branch of study.
The 19th Century gave way to some very momentous moments in dentistry. The first American dental book was published in 1801. In 1832, the reclining dental chair as we know it today was invented.
In 1839 vulcanized rubber and the American Journal of Dental Science were introduced, both highly important for their time. In 1859, 26 scientists got together to form the American Dental Association.
1867 included the creation of Harvard’s dental school, and in 1899 malocclusions types were identified, sophisticating the specialization of modern orthodontics.
Lastly in the last hundred years, great leaps have been made to get to modern dentistry. Water and toothpaste fluoridation, as well as the nylon toothbrush, revolutionized greater access to preventative and maintained dental care.
Implants and dental prosthetics were overhauled to be cheaper, more durable, and safer. Laser treatment for tooth decay and technological advancements in computation have optimized dentistry in incredible ways, and are continuing to evolve.
The point for this brief history lesson is to put into perspective the thousands of years that have evolved to the summit of knowledge backing how we take care of our dental health today.
The doctors, dentists, and orthodontists we have today have studied material and continue to evolve the understanding of how to live healthier and more full lives through dental well-being. Because of this, having a dental plan is just as essential as having a standard medical insurance for your general health needs.
What does dental insurance cover?
A dental plan, or dental insurance, is a plan that provides medical coverage benefits. Insurance is much less akin to your car insurance and closer to medical insurance.
While automobile insurance is intended to cover damage in the case of an accident, dental insurance is preventative and about routine care to stay in overall good health. And because procedures can be pricey, it is worth looking into a good dental plan that covers any needs you may have.
The common benefits generally covered broadly by most plans can be divided namely into two main categories–routine preventative care, and non-routine care. It is as follows:
Routine Preventative Care (generally 100% covered by most plans):
- Professional Cleanings
- Fluoride treatments
Non-Routine Care (Typically covered partially by insurance):
- Extractions and related oral surgical procedures
- Periodontal treatments
- Root Canals
- Emergency services
Routine Preventative Care Breakdown
For someone who may be new to the dental world, knowing what the different dental procedures are is instrumental to determine what kind of care you may find yourself needing.
Knowing what kind of coverage fits your necessities or desires is then integral before choosing a plan, saving you money or the hassle of wondering if your plan covers a procedure you need but did not know about.
Dental exams are perhaps the most important of all dental procedures. This is where your dentists check up on the overall state of your teeth and gums, typically twice a year.
It’s the most preventive assessment for your overall health as a dentist can typically detect gum disease, tooth decay, oral infections, and cavities, amongst other oral health problems.
You may receive x-rays and typically a cleaning. X-rays find cavities or other issues, and cleanings are often what most need to stay in overall good shape.
Cleanings are simple procedures where plaque and stains are removed from teeth, and some deeper gum cleaning if one happens to have a gum infection like gingivitis.
Fluoride treatments are like your dental cleaning in that it is a procedure done at the dentist’s office, and is done on the teeth to clean them from any bad bacteria. Usually, a quicker process than cleaning and can be avoided by routine brushing with a fluoride toothpaste.
Sealants are typically plastic protective coatings of sensitive areas around teeth that are hard to brush often. It is a form of preventative care to avoid cavities.
X-rays are important images that allow a dentist to see the nitty gritty of what is going on inside your teeth and may not be directly clear on the outside. Cavities, root canals, cysts, or tumors can all be seen through an x-ray, and thus are imperative to good preventative care.
Fillings…most people know this is a not so fun, but still very much necessary, procedure. It consists of filling in cavities with any amalgam of metal or plastics to prevent any further decay or infections from residing.
Extractions are pretty simple: you have a tooth removed that is either decaying too much or is obstructive to your overall tooth organization.
Root canals sound terrifying, but they are similar to cavity fillings, only that they are used to treat the soft tissue inside a decayed tooth.
Crowns and bridges are dental prosthetics used to restructure a damaged tooth into proper working condition.
Orthodontics is the condition of how your teeth are aligned. Sometimes it may require braces, but other times less intrusive mouthpieces are all that is needed.
Dental emergencies are any set of conditions that are important to take care of immediately in order to assure one’s overall immediate health is maintained.
Knowing what kind of care you may need is important to help you better know what kind of dental plans you may need.
Types of Dental Plans
Before delving into the types of plans available, there is another tidbit of information helpful to understanding the types of plans. Knowing the following terms will help:
- Premiums: A premium is a monthly amount paid for a plan
- Deductibles: Out of pocket expenses covered by you before the insurance starts paying
- Coinsurance: Aside from the deductible, this is usually a percentage of coverage expenses that you must cover
- Copay: A copay is a fixed cost for certain services. X-rays or visits may require a copay.
- Maximum: The maximum amount of coverage provided, where any additional costs are co-insured by you
Now, onto the various types of dental insurances available to you. The following are the most prevalent:
- Preferred provider organization (PPO)
- Health maintenance organization (HMO)
- Indemnity plan
- Exclusive provider organization (EPO)
- Table/Schedule of allowance
- Payment plan
As stated before, PPO stands for Preferred Provider Organization. A PPO is a medical plan where medical professional personnel and facilities provide care at reduced rates to subscribed clients.
PPOs typically have a wide variety of medical personnel to choose from. As an exchange for the lowered rates, the insurers pay a PPO for access to their pool and network of medical professionals.
PPOs can have providers across cities or even states. These plans also usually have co-payments for visits or retain a deductible the insurer has to pay before the insurance does. The PPOs may often also have a maximum, but generally, cleanings, exams, and x-rays are covered completely.
- Typically large networks, with discounts for in-network dentists
- You don’t have to use in-network dentists
- Largest span of procedure coverage, generally
- Lower out-of-pocket copays
- Typically this is the type of plan with the highest premiums
- If you go out of network, it isn’t as cheap as staying in-network
- Passing your maximum coverage leaves the rest of the expenses on you
Dental health maintenance organizations (DHMOs) are dental insurance plans which have their own network of dentists under a contract which offer their services and care at discounted rates to members of the insurance.
Typically, these kinds of plans are used by employers to provide insurance for their employees, but it is not necessary to get it through a business. Individuals can elect to have DHMO insurance.
The pros of DHMO insurance plans is that they are typically cheaper than PPOs due to their lower premiums and typically lower deductibles.
The downsides or cons of DHMOs is that they tend to be strict about staying within their network of doctors, potentially leaving a potentially large tab if one goes out of network.
DHMOs also typically have referrals to dentists and the process can be tiresome, as well as the potential to have a dentist office where the dental professionals don’t provide as much attention due to high volumes of fellow insurance-subscribers.
Still, if looking to save money, a DHMO could be ideal, especially if one is patient.
- Cheaper premiums than a PPO
- Most routine preventative care is 100 percent covered, with some copays for non-preventative procedures
- A wide selection of dentists available to you
- A strict list of in-network dentists
- Some procedures may have very little to no coverage at all
- Copays tend to be higher than on a PPO plan
Indemnity insurance is an insurance policy that does not have some sort of organization or network of dental professionals one has to choose from.
Quite the opposite, with indemnity insurance, the enrollee is free to choose any dentist’s office without the need for any referrals, or delays of verification.
Any dentist or specialist of choice is a fair game. Still present are deductibles, which again are only necessary if the expenses of a procedure extend over your maximum coverage.
The way indemnity insurance works is that you pay fees, but you also pay for your treatment and have a percentage of it reimbursed later. Because of all the freedoms associated with indemnity plans, they tend to be the most expensive.
The benefits of Indemnity insurance is that you can see whichever dentist or orthodontist you want, without any referral prior to a visit. Another benefit is that typically, cleanings, exams, and x-rays are generally covered by a full reimbursement.
Usually, the more preventive and routine types of care come with better reimbursement, thus rewarding good general health versus depending on emergency care.
The downside is that reimbursements are not immediate, and more complex procedures, such as root canals, may not be covered by some indemnity insurances.
- No networks allow you to choose your own dentist
- No referrals needed for specialists
- You can often submit a claim to determine how much the insurance will pay on a specific procedure, before actually going through with it
- Higher premiums
- Some procedures may not be covered
- You pay out of pocket for a procedure in full, and then get a percent reimbursement later
These plans work like a membership rather than a subscription. Think of Costco or Sam’s Club, where you show your membership card and pay discounted prices. Similarly, you pay once versus monthly, and you pay for the dental services you need at a discounted rate
Pros to this system include the incredibly low prices on insurance, with no real premiums. If you are generally healthy and don’t require much to any work aside from a cleaning or a routine exam, you are typically covered in full.
Cons include paying out of pocket for any work you might need that could potentially be covered by a different type of insurance plan. The other con is that you still need to be in-network for dentistry. Still, this option is good for healthy individuals looking to save some big bucks.
- Very low cost, and no monthly premiums
- Most basic services for keeping general dental health are covered in full
- Some discounts on certain dental procedures
- Can often be combined with other insurances
- Most dental procedures outside of basic dental care will
- Despite offering a discount, significant out-of-pocket expenses
An exclusive provider organization is much like a hybrid of the previously mentioned PPO and HMOs. The neat difference is that EPOs typically offer a wider range of dental practitioners to choose from than an HMO, and there are no referrals necessary, typically.
This type of plan is ideal for those who travel often and may need more dental coverage. These plans are priced lower than most dental PPOs, but are also generally pricier than HMOs.
- Large, multi-state spanning coverage
- A wide selection of dental providers to choose from
- Often more expensive than HMOs, and closer to PPOs in premium pricing
- Still will have significant out-of-pocket expenses
Table/Schedule of Allowance
A table plan, or schedule of allowance plan is much like an indemnity, with the major difference being fixed prices on procedures, where one pays a specific predetermined amount out of pocket on a procedure. This type of plan can potentially be paired with a PPO that caps certain dentists’ procedures to a fixed price.
- Knowing how much you are expected to pay for a procedure
- Significant discount over usual and customary fees
- Paying out of pocket for more complex procedures
- Higher fees and copays versus a PPO or HMO plan
The last type of plan on the list isn’t actually insurance, but rather a way to obtain dental care if insurance isn’t possible. These plans are particular to individual dentists’ offices and are a direct full payment for dental procedures with a timeframe to pay back the expenses.
These can be difficult plans as the plans often have interest in the payments, or have no interest, so long as payments are made on time.
- Access to dental care, an important aspect of overall health
- 0 interest if paid on time
- Costly, as you’re still paying out of pocket
- Interest if your plan consists of it, or interest if payments not timely (on a 0 percent interest plan)
Frequently Asked Questions
If your needs may require some complex procedures, or you like having a large safety net in the case you might need a complex procedure, a PPO would be your best bet, considering the prices of procedures may be more than the high premiums of insurance. An EPO would be best if you also happen to travel often.
Though more expensive, Indemnity plans are preferable over the PPOs if you want a very specific dentist or specialist, while still maintaining some coverage.
If you have procedures you need or may need, but don’t want to pay higher premiums and are okay with having a smaller network of dentists–HMO plans are ideal
If you are generally healthy, and anticipate needing much dental work outside of your regular maintenance, and want to save money, discount plans would be best.
If dental insurance is inaccessible, payment plans are the best option, and worth seeking a dentist that offers it.
The best way to find a dentist is by visiting your insurance’s website or calling them for in-network or discounted dentists near you. The second option is to call available dentists accepting patients, and asking which insurances they accept.
The Affordable Care Act does not require you to have dental insurance. You will not face any tax penalties for not having dental insurance. The Affordable Care Act does require that you are offered dental insurance if you have children, but it is not required to get dental insurance.
Frequently there is a waiting period. Generally for extractions or fillings, a 4 to 6 month waiting period is common. For more complex procedures like crowns and bridges, it may be closer to around 12 months.
Typically, when there are situations involving two different insurances, it is the result of two partners who both have insurances from their employers. You can have two insurances, but their benefits do not ‘double.’ The best way to determine the benefits of having two dental insurances isby calling them directly.
The study of dental practice spans back many thousands of years and many cultures. Technology and human knowledge has come a long way to make sure we are healthy.
Another important notion to take away is that for thousands of years, humans have realized the importance and significance of dental health on the overall wellbeing of a human.
Not only is our mouth what allows us to eat properly, but it is also what allows us to speak, smile, kiss, laugh, and do so much more. It is important that dental health is taken seriously and prioritized.
The general theme for most of the plans is that routine preventative care is often the best insurance. If you are healthy, you will tend to stay healthy, and thus save money by not letting those sensitive systems start to decay.
That being said, reading through the informative provides all the information on what one can expect from each type of plan. Determining which type of plan sounds ideal allows you to decide where to look further in your shopping when it comes to specific insurance providers.
Also worth considering is that many companies and businesses actually offer dental for employees, so it is worth checking with your human resources department, or managing parties for more information.
If you are looking for further venture though plans available to you in your area, this search tool is helpful to locate the plans around your city or state.