Shopping for individual dental insurance can be overwhelming if you are self-employed or do not have group dental coverage through your employer. To narrow your options, visit your dentist for an exam and diagnostic X-rays to get an accurate picture of any complex procedures you or your family might need in the future.
Premiums
As with any insurance, the premiums determine how much the plan costs. If you’re purchasing a dental policy on your own instead of through an employer (or as a rider to another health policy), premiums are one of the primary considerations.
It’s also essential to check how extensive the dental provider network is. Most individual DPPO plans have a find-a-dentist tool that allows you to plug in your preferred dentist’s name and see if they are in the network. If they are, you’ll save by going to an in-network dentist.
Typically, a DPPO will cover preventive care like cleanings at 100%, basic procedures like fillings at 70%, and major procedures like crowns or bridges at 50%. Some individual DPPOs even waive the deductible for preventive care.
Deductibles
While most people get individual dental insurance plans through their employers, AARP, the Affordable Care Act marketplace, or public programs such as Medicaid and the Children’s Health Insurance Program, it’s possible to purchase individual coverage. It’s essential to closely examine a plan’s details before you buy, including premiums, deductibles, and annual maximums.
When comparing plans, it’s also essential to consider the size of a plan’s provider network. Dental HMOs typically have smaller networks within a limited geographic area, while PPOs offer more flexibility. Also, find out how many preventive visits a plan covers. Most dental plans cover two cleanings and exams yearly, but comprehensive policies often include additional services such as fillings, root canals, and tooth extractions.
It’s essential to find a dentist you and your family feel comfortable with, regardless of insurance. Visiting a dentist you trust can help ensure you use your benefits and encourage regular dental checkups. Additionally, a dentist who accepts your insurance can make getting care much more accessible. Most insurance carriers have a “find a dentist” tool on their websites to help you locate in-network providers.
Co-payments
When shopping for an individual dental insurance plan, comparing the cost of monthly premiums, deductibles, and co-payments (the amount you pay at each visit) is essential. Also, consider whether the insurer has a good reputation and remains financially stable.
Co-payments, specified as fixed dollar amounts for particular services, can offer more predictability than deductibles in out-of-pocket costs. However, co-payments are typically only found on Dental Health Maintenance Organization (DHMO)-style plans.
DHMOs tend to have lower premiums and no annual maximum for coverage, but they also limit your choice of dentists by offering only their provider network. This may be fine for you, but it’s something to remember when evaluating these plans.
Other options include Dental Preferred Provider Organizations (DPPO), which generally have higher monthly premiums but offer more flexibility for seeing out-of-network dentists. Indemnity plans let you choose any dentist and reimburse a percentage of the fees your insurance company considers “reasonable and customary.” These plans often have higher annual limits for coverage, but their out-of-pocket costs are usually more expensive.
Benefits
Individual dental insurance can be a cost-effective alternative to employer group coverage. It covers out-of-pocket costs for routine visits and major procedures, such as crowns or bridges.
When shopping for a plan, consider factors such as monthly premiums, deductibles, co-payments, and the size of the provider network. An extensive network can offer flexibility, as many plans will allow you to visit any dentist in your area.
Another factor to consider is the annual maximum on a dental plan. Most insurance companies cap the amount they will pay for a year’s worth of services, and after that, you are responsible for all costs.
Also, if you have a favorite dentist already, check to see if they are in the insurance company’s provider network. If they are not, consider a different plan with a more extensive network. This is especially important if you need a costly procedure.
Limitations
When selecting an individual dental insurance plan, it’s essential to consider the limitations that may be imposed on a policy. Most plans offer a range of options to choose from. For example, some plans let patients visit any dentist, while others limit visits to a list of dentists who have signed contracts with the insurance company.
These are known as PPO or preferred provider organization plans. They pair traditional indemnity insurance with a network of dentists who have agreed to accept the plan’s fees for services, which are often lower than what non-contracted dentists charge. These plans may also include maximum charges or points of service options.
Conclusion
Most individual dental insurance policies have annual maximums, the total dollar amount a plan will pay for a calendar year. In addition, most plans have frequency restrictions, such as two cleanings and X-rays per year. Understanding these limits and how they compare to your anticipated treatment needs is essential. Also, consider whether a plan has cost containment features or pre-existing condition exclusions.