Dental Care Plans

Discover the benefits of Dental Care Plans for optimal oral health. Explore our comprehensive guide to dental insurance, coverage options, and preventive care. Find the perfect dental plan tailored to your needs, ensuring a confident smile and peace of mind. Stay informed on the latest trends in dental care and make informed decisions about your oral well-being. Unlock the key to a brighter, healthier smile with our insights into Dental Care Plans. Explore now!

Categories of Dental Treatment

1. Diagnostic and Preventive

An important feature of a dental insurance plan, which is typically not found in a medical expense insurance plan, is the inclusion of diagnostic and preventive care. Most dental plans provide coverage for routine preventive procedures such as periodic teeth cleaning and fluoride treatments. An increasing number of dental plans require periodic examinations as a condition for continued coverage.

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2. Restorative

Restorative care means treatments, which restore functional use to natural teeth such as fillings or crowns.

3. Oral Surgery

Oral surgery means operative treatment of the mouth such as extractions of teeth and related surgical treatment.

4. Endodontics

Endodontics means treatment of the dental pulp within natural teeth, such as a root canal.

5. Periodontics

Periodontics means the treatment of the surrounding and supporting tissue of the teeth such as treatment for gum disease.

6. Prosthodontics

Prosthodontics means the replacement of missing teeth with artificial devices like bridgework or dentures.

7. Orthodontics

Orthodontics means treatment of natural teeth to prevent and/or correct dental anomalies with braces or appliances.

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Dental insurance differs from medical expense insurance in that it is diagnostic and preventive.
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Indemnity Plans

There are three different types of indemnity plans available, including

  • Scheduled or basic plan;
  • Comprehensive or nonscheduled plan; and
  • Combination of both basic and comprehensive plans.

1. Choice of Providers

Some dental plans limit the insured’s choices of providers, but others simply limit the benefits to any qualified practitioner.

2. Scheduled vs. Nonscheduled Plans

Scheduled Plans

Basic or scheduled plans pay benefits from a list of procedures up to the amount shown in the schedule. Most plans provide first-dollar benefits without coinsurance or deductibles. Maximum benefits are often lower than the usual and customary charges of dentists who force the insured to bear a portion of the cost.

Nonscheduled Plans

With nonscheduled plans, benefits are paid on a reasonable and customary basis and are subject to deductibles and coinsurance. Services are usually divided into three broad benefit categories: diagnostic/preventive services, basic services, and major services.

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Scheduled plans = no coinsurance or deductibles; nonscheduled plans = coinsurance and deductibles.
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3. Benefit Categories

Dental insurance plans typically provide coverage for the following types of treatment.

Diagnostic and Preventive Services

Diagnostic/Preventive Services generally are not subject to coinsurance or deductibles.

Basic Services

Basic Services such as fillings, oral surgery, periodontics, and endodontics may require the insured to pay a deductible or 20% of the balance (the insurer would pay the other 80%).

Major Services

Major Services, such as inlays, crowns, dentures and orthodontics, could either have large deductibles or pay around 50% for services provided.

4. Deductibles and Coinsurance

Most dental plans have a deductible amount such as $25, $50, or $100, which must be met each calendar year. Generally the deductible does not apply to preventive care like cleaning and routine examinations.

5. Combination Plans

Combination plans combine features of both the basic and comprehensive plans. They generally cover diagnostic and preventive services on a usual and customary basis but still use a fee schedule for other dental services.

6. Exclusions

Dental plans typically exclude cosmetic services (unless required by an accident), replacement of lost dentures, duplicate dentures, oral hygiene instruction, occupational injuries covered by workers compensation, or services provided by government agencies.

7. Limitations

To help keep costs down, dental plans provide more limitations than deductibles and copayments. Most plans provide for calendar year maximum benefits and lifetime maximum benefits. Routine exams and cleaning are generally limited to once every 6 months, full mouth x-rays to once every 2 to 3 years, and replacement of dentures to once every 5 years.

8. Predetermination of Benefits

The predetermination of benefits (precertification or prior authorization) clause is found in most dental plans. This service, although generally not mandatory, will allow the insured and the dentist to know in advance what benefits will be paid.

Employer Group Dental Expense

Dental plans can be found in the form of individual plans or as group plans provided through the employer. Generally included in an employer group dental insurance plan is preventive care for up to two visits per year. However, it will not provide coverage for cosmetic treatment, and there may be limits on procedures such as braces or other appliances.

1. Integrated Deductibles vs. Stand-Alone Plans

Dental expense may be packaged or integrated with other health insurance benefits like major medical. In that case the integrated plan may have a common deductible. On the other hand, some integrated plans maintain separate deductibles for the medical and dental portions of the contract.

2. Minimizing Adverse Selection

Dental plans attempt to minimize adverse selection by utilizing probationary periods, where insureds that had no prior dental coverage are likely to have a large number of untreated dental problems. There can also be a limitation on benefits for late enrollees where benefits may be reduced for the first year. Even though dental coverage is regulated by COBRA continuation rules, it is seldom convertible like individual health insurance.

Pediatric Dental Coverage

Pediatric dental coverage is an essential health benefit under the Affordable Care Act that must be available as part of a health plan or as a stand-alone plan for children 18 or younger. However, insurers do not have to offer adult dental coverage.

Depending on the state, pediatric dental benefits may be offered through one of the following types of plans:

  • A qualified health plan that includes dental coverage;
  • A stand-alone dental plan purchased in conjunction with a qualified health plan; or
  • A contracted/bundled plan.
Health insurers must offer pediatric dental coverage (for children 18 or younger) as an essential health benefit under a health plan or as a stand-alone dental plan.
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Ethan Wrenn

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Dental Care Plans

Discover the benefits of Dental Care Plans for optimal oral health. Explore our comprehensive guide to dental insurance, coverage options, and preventive care. Find the perfect dental plan tailored to your needs, ensuring a confident smile and peace of mind. Stay informed on the latest trends in dental care and make informed decisions about your oral well-being. Unlock the key to a brighter, healthier smile with our insights into Dental Care Plans. Explore now!

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