*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
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).
There are few procedures that most insurance companies will not cover or only provide a discount for. Most individual dental insurance plans do not cover what might be considered cosmetic procedures such as tooth-colored fillings on molar or bicuspid teeth, dental implants or adult cosmetic orthodontics. The majority of dental companies will also limit how often certain appliances can be replaced and, in most cases, will not replace lost items. The limitations are published in the disclosures and contracts for the plan, many of which you can peruse online. Keep in mind that a new dental insurance plan is not going to cover an emergency you are experiencing right now; most have a waiting period of six to 12 months for major work. (However, some will waive the waiting period if you recently had dental insurance.) Dental groups that offer dental discount plans will let you use your benefits right away, but they only provide a discount and not full coverage. Full coverage plans will however cover your initial evaluation so you can start planning your dental procedures.
But for many, the perceived high cost of dental insurance is one of the key factors that is keeping them from getting a policy. Luckily, there are a number of different options for people at different price points. According to the National Association of Dental Plans, the average annual cost of coverage in 2009 (the most recent year the survey was conducted) for a dental HMO plan was around $225 per year for an individual or $445 per family, the cost of a dental PPO plan averaged around $285 for an individual and $866 per family, and indemnity plans cost an average of $288 for an individual and $666 for a family.
After considering the best 10 dental insurance providers, Delta Dental earned our pick for the best dental insurance overall. This provider provides excellent value and flexibility of plans, and allows you to manage claims via a computer or mobile device. While plans and pricing vary by state and individual needs, Delta Dental offers significant savings on average versus going it alone with preventative care, which is why it's your best option for dental insurance.
Preventive care is 100% covered with 2 exams and 3 cleanings free per year. There is a $100 deductible that you only pay once for the life of your plan. After the deductible is met, the plans cover between 80% to 90% of all basic care and 50% to 65% of major work including crowns, bridges, implants, and root canals. Orthodontia is covered at 50% and all plans are highly affordable, with their lowest individual plan often running at less than $115 per month depending on your region. Their highest-tier plan offers a $5,000 maximum benefit per year but isn’t available in every state.
Another option for dental care is Medicaid, which covers some kinds of dental procedures if you meet the requirements. Medicare does not provide dental coverage. The ADA Foundation has provided dental care to 5.5 million children since 2003. They will direct you to a dentist that is near you. Another option is the Children Health Insurance Program (CHIP). It provides health coverage including dental coverage to over 7 million children under 19 years of age.
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.
Humana individual dental plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Benefit Plan of Louisiana, Inc., or DentiCare, Inc. (DBA CompBenefits). Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. Arizona residents insured by Humana Insurance Company. Texas residents insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits).