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Dental Insurance 101

What is dental insurance? It is insurance coverage designed to cover expenses related to dental care. Much like health insurance, dental insurance will cover a percentage of the expenses related to one’s oral health.

Click here to get a quoteWhy purchase dental insurance? Just like other forms of insurance, individuals purchase dental insurance to help offset the expenses of taking care of their teeth and oral health. Most dental insurance plans provide some form of annual preventative care to encourage good health as well as coverage for more involved services like fillings, crowns, and root canals. In recent years, more links have been made to the health of people’s teeth and gums and their overall physical health.

What types of dental insurance plans are there? There are generally three main types of dental insurance plans available: Dental Health Maintenance Organization (DHMO), Dental Preferred Provider Organization (PPO) Plans and Dental Point of Service (POS) Plans.

What is a Dental HMO (DHMO)? With a DHMO, members must select a Primary Care Dentist (PCD) and he or she is considered the gatekeeper to the member accessing other dental specialists. DHMO premiums typically cost less and members experience lower out-of-pocket costs than with Dental PPO plans. DHMOs often provide broad preventative care and members usually will not receive bills for services as the billing is handled directly between the providers and insurance company.

What is a Dental Preferred Provider Organization (PPO)? With a Dental PPO, members have access to a network of dentists with discounted services. Unlike DHMOs, Dental PPOs offer members the flexibility to see any provider either in the network or out of network. Dental PPOs typically have an annual deductible and co-insurance (a cost sharing percentage) maximum (out-of-pocket) the member must meet before most expenses are covered by the insurance company. When seeking out of network benefits, members will likely pay more out-of-pocket due to not having the negotiating power the dental insurance company has arranged with providers in-network.

What is a Dental Point of Service (POS) Plan? POS stands for Point of Service Plan. With a Dental POS plan, insured members have access to the broadest dental care choices. Dental POS members usually have access to a DHMO network through a Primary Care Dentist, participating providers of a PPO network, or by going completely out-of-network to non-participating providers.

What does co-pay mean? A co-pay is usually a fixed dollar amount the insured member pays for a service (i.e., a dentist visit co-pay with a DHMO of $15 for a routine dental visit). Once the member pays the co-pay for services the dental insurance company normally pays the rest of that service.

What does deductible mean? A deductible is typically tied to a calendar year and is an amount the insured member must pay up front before the dental insurance company starts participating in the payment for services.

What does co-insurance mean? Co-insurance is a percentage that the dental insurance company and insured member share together once the annual deductible has been met. For example some dental plans may state the co-insurance is 80%/20% for in-network services. In this example, after the member meets their annual deductible, the dental insurance company would start paying 80% of the claim and the member would pay 20% up to their out-of-pocket maximum.

What does annual year maximum benefit mean? Dental PPOs plans usually have an annual year maximum allowable benefit amount per member. It is the maximum dollar amount the insurance company will provide for a member during the calendar or plan year. For example, if a dental plan provides up to $1,000 of annual maximum benefit, that is the limit each family member will be able to receive for dental services that year. The benefit will reset for the members at the start of a new calendar or plan year.

What does in-network and out-of-network mean? In-network refers to services received from a dental providers the insurance company has negotiated discounts with on behalf of their members. Out-of-network refers to providers that are not contracted with the dental insurance company, meaning the insured members would be required to pay more out of pocket for services.

How would I know what dental plan to pick? There are many options to select from and you will need to; 1) Ask your dentist what dental plans they accept and are a provider of, 2) evaluate your budget to make sure the coverage is affordable. You can start by evaluating plans yourself online or by contacting one of our representatives now.

What are the prices for dental insurance plans? Rates are set by the insurance companies and our prices are very competitive, the same as going directly through an insurance company. Prices will vary based on a number of factors, such as applying for an individual dental plan or desiring a group dental plan for your business.

Individual dental insurance plan benefits and rates are quoted when applying for certain individual and family stand alone health insurance plans. For individual and family dental insurance quotes please see below. For small business dental insurance options please complete the form found at the bottom of the page Small Business Health Insurance.

How do you apply for a dental insurance plan? You can request dental insurance when completing an online application for certain individual and family health insurance plans. Alternatively, for those individuals wanting a stand alone dental insurance quote please complete the following form and we will email you plan benefits, rates and an application.

800-858-5555