Getting the right coverage for you takes investigation

Let’s face it: Getting dental work done can be expensive. Even the most basic cleaning can put a dent in your pocketbook. Having comprehensive dental insurance may mean the difference between putting off important oral healthcare or living with gum problems or a mouthful of cavities. However, because of the way certain policies are designed, you may be limited in what work you can get completed.

The Basics of Dental Insurance

Dental insurance gives you coverage to help pay for certain dental work. These policies can help insured parties pay for all or part of the work their dentists perform, from routine cleanings and X-rays to more-complicated ones such as implants.

Although dental insurance works a little like health insurance, the premiums are typically much lower—but, of course, there’s a catch. Most health insurance policies cover a hefty percentage of even towering expenses once you’ve paid your deductible, and many have an annual out-of-pocket maximum, along with a $50 to $100 deductible. This is not the case with dental insurance, which usually follows a 100-80-50 coverage structure.

If you are using in-network dentists, dental plans generally pay 100% of preventive care—exams, X-rays, and cleanings. Basic procedures, however, such as fillings, root canals, and extractions, only pay 80%, while major procedures such as crowns, bridges, implants, and gum-disease treatment may only be 50% of the cost. Orthodontia and cosmetic dentistry, which are not deemed medically necessary treatments, are usually not covered at all.1 This means you may still have to pay a hefty price to get your work done.

Indemnity Dental Plans

These plans tend to be the most expensive and aren’t as common in the market. They’re also often called “fee-for-service plans.” Insurers cap the amount of money they’ll pay for various procedures—a usual and customary amount set by the American Dental Association. If your dentist charges a higher amount, you’ll have to pay this amount out of pocket.

Most insurance companies that offer indemnity plans require you to pay for the entire cost and file a claim. Once the claim is approved, the insurance company reimburses you for its portion. The main advantage to having a plan like this is that it doesn’t come with a network, so you’re free to choose any dentist you like.

Preferred Provider Organization (PPO)

A preferred provider organization (PPO) is one of the most common types of plans available. Dentists join a PPO network and negotiate their fee structure with insurers. If you decide to use an out-of-network provider, you’ll have to pay more out of pocket.

These plans can be more expensive because of the associated administrative costs. Still, they do provide more flexibility than other plans, because they often come with a wider network.

Health Maintenance Organization (HMO)

With a health maintenance organization (HMO), you’ll pay monthly or annual premiums but are restricted to the network, and you may have to live within the area where the HMO is offered. It’s generally the cheapest of the three types of plans, with dentists agreeing to charge fees for specific services.3