Notice that we have used the term dental benefit plan and not dental insurance. Insurance plans are designed to make you whole in the event of a loss. Insurance, by definition, entails a risk of loss to the insurance company. Typical dental benefit plans are not designed to cover all dental procedures, and dental benefits coverage is not based on what you need or what the dentist recommends.
Dental benefit plans are not designed to cover all dental procedures. Plans usually cover some, but not all, of your dental costs and needs. Many plans involve a contract between your employer and a dental plan, but you can also purchase individual plans on your own or through the Health Insurance Marketplaces.
Your dentist’s main goal is to help you maintain good dental health, but not every procedure your dentist recommends will be covered. To avoid surprises on your bill, it is important to understand what and how much your plan will pay.
Here are a few points to consider when choosing your dentist:
PPO and DHMO: alphabet soup or dental plan? Sorting through different dental plans can sometimes feel overwhelming. Get a breakdown of your options, and find out which one is best for you.
Preferred Provider Organization (PPO)
A PPO is a dental plan that uses a network of dentists who have agreed to provide dental services for set fees. The number of dental services covered depends on the plan. If you have a PPO plan and see a dentist out of the network, you will most likely have more out of pocket expenses.
Dental Health Maintenance Organization (DHMO)
A DHMO is like an HMO. Network dentists are paid a set fee every month to provide covered dental services to you whether you see the dentist or not. Typically, some of the covered services have no cost to you, or you may have to make an out of pocket payment for the service.
Discount or Referral Dental Plans
Discount and referral plans are technically not benefit plans. The company selling the plan contracts with a group of dentists. These groups of dentists agree to discount their dental fees. Discounts are usually applied to all services including cosmetic. These plans do not pay for any services received, instead, you pay the full cost of treatment at the reduced rate determined by the plan.
Seeking advice from your dentist on the status of your dental health and care needs may help you select the best plan for you.
When reviewing dental benefit plans you may come across terms that you are not familiar with. Don’t feel intimidated. The chart below shows terms frequently used in dental benefit plans and compares them to the terms you may commonly associate them with.
Tooth Colored Filling
Early Gum Disease
Tooth Buried in Bone
Advanced Gum Disease
Scaling and Root Planing
Plastic Coating on Teeth
Not all employers offer dental benefits. If you’re struggling to find affordable dental coverage, here are some places to start.
Ask Your Dentist
Some dental offices are starting to establish dental membership savings plans. Typically, these plans charge you a fixed dollar amount on an annual basis and cover certain procedures at no additional charge (for example, cleanings and exams). After that, other procedures are discounted. Ask your dentist if he or she offers such a plan.
For more information, please visit the National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services or the Association of State and Territorial Dental Directors.
Links to Help You Choose Marketplace Insurance
Healthcare.gov has a number of resources available to help you choose the plan that best fits you. Use these resources when making your decision.
If you have questions or need additional assistance, you may call the Department of Health and Human Services’ Hotline at 800-318-2596.