Another benefit is that you have more flexibility when it comes to choosing what type of plan you want. When you work for an employer, they choose which plan they believe would be right for the majority of their workers. But you might not need the same type of coverage as the person who works in the cubicle next to you. By buying an individual plan, you're able to customize and purchase exactly what you need. For that reason, your coverage can actually be less expensive than if you had an employer-sponsored plan – especially if you had to pay for part of your premiums.
Most people know that they need to visit a dentist regularly. Having dental coverage is strongly associated with how often dental services are used. Americans often say that the cost of dental care and the lack of dental coverage are reasons for not getting needed dental care. Having an individual dental insurance plan from Spirit Dental allows you to get the regular care you need to stay healthy.
A carrier recently told us that many seniors expect to carry over their dental coverage from their employer. Yet, that rarely happens. What does happen is that about 90% of seniors on Medicare don’t have proper dental coverage (American Dental Association). After filling out the Medicare paperwork, most seniors put dental insurance on the back burner. (And vision and hearing, too…we’ll get to those later.) And, why not? Your teeth are not hurting yet and they feel pretty good.
With the rising cost of going to the dentist, many people are struggling with the decision of whether or not to purchase dental insurance. Whether you are considering buying dental insurance through your employer or independently, be sure to investigate several different plans and ask questions about the factors listed below. This information will help you choose the right dental insurance plan before signing on the dotted line.
Since this is an indemnity plan, you can use other insurances or coverage. A dental discount plan can work well here. Using the above example, if the dentist routinely charges $200 for cleaning, but per the discount plan contract, charges you $100, you will have a net cost of $10. Remember, most discount dental plans charge between $8 and $15 per month depending on other features.
If you go to an out-of-network dentist, then the plan usually pays based on the UCR fee. For example, if the dentist charges $250 for the filling, but the UCR in your area is $150, you could end up paying more. In this case, $130 ($250 – $150 X (.80)). This also introduces the concept of balanced billing, which means paying the dentist the cost difference between their rate ($250 in this case) and the cost-sharing rate ($120).
PPO Plan B has slightly lower premiums and still covers many basic services. The annual deductible is $100 with an annual maximum of $1,000. Keep in mind you are trading in the lower deductible for a higher one but you are also receiving a lower monthly premium. You have 80 percent coverage for three dental cleanings and exams per year and coverage is available for major services including implants, crows, bridges and dentures after one year of continuous coverage. You can visit any licensed dentist but save more by choosing a preferred in-network provider.
In either case, in our opinion, the purchase of dental insurance can be hard if you don’t do your homework. Why? The premiums aren’t in favor of the benefit. For example, if you are paying $100 per month for dental insurance which has an annual benefit of $1,000, that really isn’t in your best interest. You are paying $1,200 annually for a $1,000 benefit. In this case, it is better to simply negotiate a discount with the dentist or utilize a dental discount plan where appropriate (more on that below).
Preventive care may seem optional if you have healthy teeth and good oral hygiene, but it saves money in the long run. I went without dental insurance for three years in my twenties, and did what most of my peers did in that situation – simply didn’t visit the dentist. Then I enrolled in a graduate program which required students to have medical and dental coverage. At my first dental visit, I had numerous cavities. Getting them all filled required nine or ten appointments in the nine months of my academic year.
They provide discounts on your claims that average around 20.3% in addition to covering a percentage of your costs. Delta Dental Premier works with a network of dentist that offer lower costs on their services which equates to cheaper treatments for you. Dentist in this network are not allowed to bill you additionally after you pay your agreed co-payment or deductible.
Medicare, the largest health insurance provider for adults 65 and older, does NOT provide coverage for routine dental care. Medicare only pays when dental care and medical needs intersect. Medigap, a private insurance plan that supplements Medicare coverage, doesn’t offer dental coverage, but some private Medicare Advantage managed care plans do offer dental benefits.
Nothing on this website guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. For a complete description of the details of your coverage, please refer to your coverage documents. Estimates may vary depending on your benefit plan and the state you live in. Claims will be processed when received according to your plan provisions.
More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” Many include at least one of these clauses, but most have both. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
If you are a senior or are approaching retirement, you may be surprised to find out that Medicare does not provide coverage for routine dental care. Medicare mainly covers medical treatments, but does not provide any assistance for routine dental care such as bi-annual exams, cleanings, or even major services like bridges or dentures. This leaves it to seniors to search for a dental plan that can meet their coverage needs.
Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment.
Because dental is not included in Original Medicare (unless medically necessary) or Medigap supplement plans, seniors must look elsewhere for dental coverage. So, dental insurance for seniors on Medicare can seem like a chore. But getting dental insurance when you’re using Medicare isn’t difficult, limited, or expensive. In fact, there are two different paths to take in order to find inexpensive coverage options.
In the United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to a DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified.
Attention: This website is operated by HealthMarkets Insurance Agency and is not the Health Insurance Marketplace website. In offering this website, HealthMarkets Insurance Agency is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov.
The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what services your dental benefits plan will cover, or your out-of-pocket costs. Estimates should not be construed as financial or medical advice. For more detailed information on your actual dental care costs, please consult your dentist or your Delta Dental.
One of the biggest downsides of paying for your own plan is that your premiums might not be pre-tax as they would be if you were paying for a plan that your employer and your contribution towards the plan was being taken off your paycheck. But, if you own your own business, you can potentially write off those expenses as a business cost and therefore get the same savings.
DHMO's are similar to HMOs in that their plans connect you with a network of dentists who give you care for a low monthly premium. With DHMO plans, you are required to go see dentists who are in their network, but in return you have lower costs, and no claim forms to fill out. DHMOs are great for preventative care and basic procedures. Some downsides include that there can be wait times if you need major or restorative dental care and some DHMOs don’t cover this types of treatment. You also need to go see your primary care dentist and get a referral to a specialist in order to get some specialized care.
UnitedHealthcare has a large number on in-network preferred providers, over 200,000, so you won’t have any trouble finding a dentist in the plan. Cleanings and X-rays are covered 100 percent. Here are the charges you pay for basic services: exam - $25; root canal - 50 percent; fililngs - 30 percent; extractions - 30 percent. The coverage has no age maximum limitations. Deductible limits are $50 - individual, $150 - family of three with a 6-12 month waiting period for certain services. Cleanings and X-rays are covered with zero co-pay or deductible twice yearly.
Discount dental plans are not insurance. However they provide a low cost alternative to dental insurance plans. Dental discount plans have a small monthly fee that allows you to receive substantial discounts for procedures with the plans’ In Network dental providers. With discount plans, you only pay the specific discounted amount for the procedures you have. These discounts can be 40-50% off typical retail costs for services. If the cost of care is a significant factor you may want to consider a discount dental plan with a carrier like Careington dental.
eHealth Insurance was started in 1997 and it was the first platform used to sell health insurance over the internet. eHealth has over 5 million customers in 50 states. The company doesn’t provide dental insurance themselves, but acts as an insurance broker or marketplace. They have partnerships with over 180 health providers and they sell over 10,000 different health insurance products online.
While we conducted extensive research, we cannot tell you exactly what your new dental plan premium will be or what it will cover. Premiums vary by zip code, age, plan type and other factors. Our reviews can tell you generally what to expect from the dental insurance companies we reviewed, but we cannot predict your exact situation. To calculate average premiums we gathered quotes from numerous areas across the nation; we chose zip codes from large metropolitan areas and from smaller cities of around 150K. We looked for premium rates for one, two and three persons. We made note of the lowest and highest premiums quoted and excluded dental discount plans and preventive-only plans. The sample terms and conditions are common scenarios, but again, these vary depending on the plans available in your area.
Guardian has dental plans for seniors that cover 100 percent of preventive services including cleanings, exams and X-rays. The only downside is it is not available in every state. For those states that are covered, seniors can obtain dental insurance that covers 100 percent of preventive services and up to 90 percent of other basic procedures such as simple extractions and fillings. Individual plans directly provided by Guardian are available to individuals living in Arizona, California, Colorado, Nevada and Utah with access through the healthcare exchange for residents of Florida, Texas, Illinois and New York.
Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Note – not all plans and offers available in all markets.