Choosing the Right Dental Plan for You | MouthHealthy - Oral Health Information from the ADA

Choosing the right dental plan for you

Even if your dental health is excellent, you may decide to carry dental coverage that helps pay for checkups, cleanings, x-rays and other services. Here are tips for comparing dental plans and choosing the one that’s right for you.

Reasons to consider a dental plan

For some people, the cost of dental coverage may actually be higher than the cost of paying the dentist directly. This might be true if you are currently seeing the dentist twice a year for routine cleanings and checkups, but you rarely need additional care. However, it might make sense to have a dental plan if:

  • Past dental expenses have created a budget crunch for you.
  • You prefer knowing approximately what you will pay for dental care each month and year.
  • You have family members who also need dental care, especially children or teens.
  • You or someone in your family might need major dental work in the future.

Keep in mind that different dental plans offer different levels of coverage, and no plan will likely pay 100% of your expenses. But even with deductibles and other plan limitations, having dental coverage can make it easier for you to manage dental costs.

How to compare dental plans

The first step is understanding the “working parts” of a dental plan. Here are some terms you need to know before you can compare plans side-by-side.

Annual limit: This is the total dollar amount a dental plan will pay during the plan year. If you opt for a family plan, there may be separate limits for each individual and for your family together. If your total dental costs exceed this limit, you will owe the amount above the limit.

Total lifetime limit: Your dental plan may specify a total, all-in limit for dental services. This is the maximum amount payable while you are enrolled in the plan, which may include several calendar years. For example, if your plan includes coverage for braces, a lifetime limit may apply to those services.

Deductible: This is the amount you are expected to pay out of pocket before your dental plan begins covering your expenses. So, for example, if your deductible is $100 and your first dental visit costs $150, the $50 above your deductible amount will be eligible for coverage, subject to coinsurance or copayments.

Most dental plans are based on a calendar year (January through December) or a plan year, which can vary by group. our deductible will apply for the year or period specified, with a new deductible applying when your coverage renews. Keep in mind that you may not meet your deductible the first time you visit the dentist. Some services — for example, cleanings and diagnostic services — may be covered automatically with no deductible.

Coinsurance: This is a form of cost-sharing that spells out what percentage of dental costs your plan will pay and what portion you must pay. For example, your plan may pay 80% of eligible expenses after your deductible and copayment (if any). You will be responsible for the other 20% of your costs.

Exclusions: These are services not covered by your plan. These might include cosmetic procedures such as tooth whitening or, in some cases, dental implants.

Frequency limitations: Dental plans may limit how often a particular service will be eligible for coverage. For example, your plan might cover no more than two cleanings per calendar year, or one cleaning within a six-month period.

Least expensive alternative treatment (LEAT): Dental plans with a LEAT clause will only pay for the least expensive treatment if there is more than one option to treat a specific dental issue. One example might include filling a cavity with an amalgam (metal) material instead of a composite filling.

Pre-existing conditions: Some dental plans do not cover dental conditions you (or a covered family member) had before you signed up for the plan. For example, if you had a missing tooth before your plan took effect, and your plan does not cover pre-existing conditions, you will need to pay the full cost of dental work to replace the tooth.

Questions to ask when comparing dental plans

Now that you know more about how dental plans work, you can begin to compare them based on deductibles, cost-sharing features and coverage limits. Here are some of the factors to weigh when you’re looking at different plans.

  • Is this a traditional dental insurance plan, or an HMO or PPO? (Here’s a review of how different types of plans work.)
  • Can you choose your own dentist or specialist, or do you have to select a provider who works with this specific dental plan?
  • What are the monthly premiums for the plan? Will your employer pay part of the premium?
  • What are the copayments, coinsurance and deductible(s) you will be responsible for?
  • What is the annual limit for this plan? Is there a lifetime benefit limit?
  • Are pre-existing conditions covered or excluded?
  • Does the plan cover braces and other orthodontic services? Are there any limitations?
  • Is emergency dental treatment covered? Can you submit expenses for emergency dental care needed when you’re traveling?

Need help? Ask your dentist

Dental plans can be complicated. Talk with your dentist if you’re not sure which one is right for you or your family. Your dentist knows your dental health history and may be familiar with the plans you’re considering. They may also refer you to another member of the dental team who handles insurance and billing, who can offer you more assistance.

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