Finding the Right Dental Insurance

Like medical insurance, dental insurance is designed to alleviate the financial burden of professional care and treatment. However, unlike medical insurance, which generally activates only during times of serious illness or injury, dental insurance usually covers regular, preventive treatment, as well.

Dental coverage is often divided into two major categories: basic and enhanced (sometimes called “major”). Basic coverage applies to routine procedures - cleanings, examinations, etc. It may also include coverage for X-rays and fillings, but often at a limited dollar amount per time period (for example, one set of X-rays every 3 years). Major coverage extends to more serious dental care - restorations, veneers, implants, etc.

The type and extent of coverage you receive will depend on your dental insurance plan and carrier. Many carriers offer plans with both basic and enhanced coverage, but the percentage of the cost covered often differs between the two. For example, your plan may allow for 100 percent reimbursement of basic procedures but only 70 percent reimbursement of major claims. Also, many plans require that major claims be pre-determined - that is, that you send in a form before any work is completed so that the carrier can a) ensure that you are eligible for coverage of the treatment and b) determine to what extent the treatment will be covered. This is also known as pre-authorization or pre-certification.

How to Choose a Dental Insurance Plan

Sometimes, dental insurance is offered through an employer, in which case you have little or no choice of providers or coverage. However, if you have the luxury of determining your own plan, look for one that:

• Lets you choose your own appointment times. While most plans have certain restrictions on how often cleanings and exams can be performed, beware of plans that are only accessible through certain dentists or that your dentist will only honor on a certain day or during certain hours. The more flexibility your plan can offer you, the better.
• Lets your dentist determine the appropriate treatment. It’s not uncommon for providers to require pre-determinations for major dental work, but try to avoid providers that only cover one type of treatment. Sometimes, your dentist may recommend another treatment option that is better suited to your particular needs and situation. Try to find a provider that allows for this - it’s unlikely that any provider will cover the full cost, but they should at least cover a portion of it. You want a provider that will work with your dentist to provide the best care for you, not one that’s only interested in the bottom line.
• Lets you see a specialist. Some dental procedures require treatment from a specialist, such as an orthodontist or an oral surgeon. Some plans and providers limit your access to specialists, while others discourage using specialists altogether. Your plan probably won’t cover the services completely, but if you think you’ll be in need of a specialist (for example, if you have teenage children with crooked teeth), look for a provider that covers at least a portion of the costs.

Individual Dental Insurance vs. Family Dental Plan

A major factor in your choice of dental plan will be who needs the coverage. If you’re single, individual dental insurance will likely be the best bet, and you can probably opt for a narrower plan, depending on your personal dental health requirements.

Couples and / or parents might require more extensive dental coverage in order to accommodate the needs of everyone on the plan. Also, the coverage offered by the plan may be different for children and adults. For example, X-rays may be allowed more frequently for children because their mouths change more often as they lose baby teeth and gain adult ones.

Keep in mind that if both partners have coverage, it may be possible to supplement one plan with the other. So, if your plan covers 80 percent of a procedure, you may be able to submit a claim for the remaining 20 percent to your partner’s provider.

Be sure to take full advantage of whatever your dental plan offers, including getting checkups as frequently as is allowed. Not only is regular dental care part of maintaining your overall health, but it can also help identify problems early, when treatment will be less extensive and less expensive.