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).
Almost all dental insurance companies use what is called a Usual, Customary, and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set.
Another kind of dental insurance plan is a DPPO which is similar to a health insurance PPO plan. What they do is they work out lower rates with dentists that are in their network who are often referred to as their preferred providers. With this plan, you can visit a dentist outside of your network, but you will not be able to get these low rates and you will likely end up paying more. Many DPPOs provide coverage of preventative care, basic procedures, and major procedures, but they only provide a percentage of this care for each.
Many seniors have dental health issues, and hope that by purchasing a standard insurance plan they will be able to afford to get treatments that they have been delaying due to cost. Unfortunately traditional dental insurance often does not cover preexisting conditions, nor will it pay to replace teeth that were lost prior to purchasing the coverage.
Dental providers contract with dental savings plans to provide the same quality dental work at reduced prices. The concept is a familiar one – it’s the same model used by discount clubs like Costco and Sam’s. Dentists realize that for many seniors, insurance is not the best option and, in many cases, doesn’t provide all of the coverage they really need. You benefit by gaining access to discounts of up to 60% on routine and major oral healthcare.
Dental health is an important part of your overall wellness, and not having insurance may tempt you to skip regular cleanings and checkups – a decision that could lead to serious dental health problems down the road. Spirit Individual Dental Insurance plans are designed to help fill these types of gaps by offering a variety of plans and price points.
The next thing that you need to look at is the yearly enrollment fee that you will be charged. This fee can vary widely between insurers. For example, Humana only charges an enrollment fee when you first enroll and not in any year afterwards. Other insurers will charge you an enrollment fee every year. These fees are generally under $50 per year, so if you find an insurer that is charging you more make sure that it’s worth it to you because you’re saving on the plan elsewhere.
With an extensive network of more than 100,000 participating dentists at more than 300,000 locations nationwide, there is likely an in-network dentist in your area. When you combine the ability to choose your preferred dentist with the kind of comprehensive coverage available through one of the largest providers in the dental insurance sector, you’ll find Guardian dental is tough to beat.

It's possible to purchase a dental-only insurance plan. You'll have to pay a monthly premium, but the cost will be offset by lower out-of-pocket fees. Most of these dental plans require that you see an in-network dentist who may offer lower rates than out-of-network providers. Some plans let you go to any dentist (in- or out-of-network), but you may have to pay more for their services.
Generally, the more complete the coverage that you are buying, the more expensive your monthly premiums will be. Dental savings plans tend to have lower monthly premiums but often not by as much as you would expect. While dental saving plans can cost under $10, there are affordable dental insurance plans that can start for as little as $20 per month and so they might be the better choice. You might have the option of paying your monthly premiums in an annual lump sum. If you can afford to do so, you generally pay a lower amount overall.
Another downside of buying your own dental insurance is that you might not be able to afford the same type of coverage, which means that you could potentially have fewer benefits than you would if you had gotten it through your employer. That might mean that you have less access to certain types of treatment or that in order to get an affordable plan with good coverage, you’ll have to choose one where you have to stay within the plan’s network.

Examples of dental costs with the Careington 500 plan are $15 for an oral exam, $31 for a cleaning, $483 for a crown and 64 percent off of dentures. The prices quoted on the website are in the Fort Worth, Texas area, with savings of 60 to 74 percent off dental services and 20 percent off orthodontia. Cost of procedures may vary depending on your location.
Often, there is no waiting period in a group plan, like one offered by an employer. Of course, if you were eligible for a company-based plan, you probably wouldn't be shopping around on your own. However, the same privilege might be had in a group plan offered through an organization such as AARP.  With their plans, there's no waiting period for preventative services, at least.   
1DeltaCare USA is underwritten in these states by these entities: AL — Alpha Dental of Alabama, Inc.; AZ — Alpha Dental of Arizona, Inc.; CA — Delta Dental of California; AR, CO, IA, MA, ME, MI, MN, NC, ND, NE, NH, OK, OR, RI, SC, SD, VT, WA, WI, WY — Dentegra Insurance Company; AK, CT, DC, DE, FL, GA, KS, LA, MS, MT, TN, WV — Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX — Alpha Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of Utah, Inc.; NM — Alpha Dental of New Mexico, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of Pennsylvania; VA – Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products. The plan is a dental HMO in CA and TX.
The final kind of dental insurance is indemnity dental coverage. These plans allow you to visit any dentist and they will pay a fee for the procedures you have done. They calculate a set amount that they’ll pay for each type of procedure and any additional amount would have to be paid by you out-of-pocket. They also have an annual maximum which can sometimes be higher than other types of plans. One of the downsides is that you have to pay for all the services upfront and submit paperwork in order to get reimbursed.
The final kind of dental insurance is indemnity dental coverage. These plans allow you to visit any dentist and they will pay a fee for the procedures you have done. They calculate a set amount that they’ll pay for each type of procedure and any additional amount would have to be paid by you out-of-pocket. They also have an annual maximum which can sometimes be higher than other types of plans. One of the downsides is that you have to pay for all the services upfront and submit paperwork in order to get reimbursed.
To begin using the Dental Care Cost Estimator tool, click the Agree button below. By clicking, you agree that you have read the information below, are accessing this information for purposes of determining treatment cost estimates for dental care services you are considering receiving, and will not use the information in this tool for a commercial or anti-competitive purpose. The costs provided in this tool are estimates only and are not a guarantee of payment or benefits. Your actual cost may be higher or lower than the estimate for various reasons.
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.
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