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Dental Insurance: Beyond Medical Coverage

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Updated May 21, 2013

Dental Insurance: Beyond Medical Coverage
KLH49/iStockphoto

Dental insurance, either provided by your employer or a policy that you buy directly from a dental insurance company, is meant to help cover some of the costs associated with your dental care.

Routine dental care, including regular checkups and preventive services, such as cleaning, is relatively inexpensive, however, restorative dental procedures such as dental implants and crowns can be quite expensive.

Although many employers provide regular health insurance as a benefit, fewer also provide dental insurance. As the cost of healthcare has increased, many employers have dropped dental coverage or shifted most of the monthly premium cost to their employees. For example, if you work for the federal government, you can get dental insurance at a relatively low cost but you will have to pay 100% of the premium.

What Does Dental Insurance Cover?

Although there are many ways that dental insurance can be provided, the typical employer dental plan uses a network of participating dentists and has the following features (depending on where you live, and the number of people in your family that are insured):

  • A maximum benefit of $1000 to $1350 per year
  • Diagnostic and preventive care (dental plan pays 100%)
  • Periodontal maintenance and cleanings (dental plan pays 80%)
  • Repair of dentures (dental plan pays 80%)
  • Basic restorative—fillings (dental plan pays 50%)
  • Oral surgery—pulling a tooth ((dental plan pays 50%)
  • Root canals (dental plan pays 50%)

After 12 months, the dental plan may pay up to 50% of the cost treating chronic gum disease, crowns, dentures, and temporomandibular joint dysfunction (TMJ) treatment. Cosmetic dental procedures (such as veneers or a smile makeover) are not typically covered by dental insurance.

The maximum benefit allowed each year and the percent that the plan pays your dentist for specific procedures will vary depending on the amount of premium you or your employer pay. The typical premium is about $50 per month.

Where Can I Buy Dental Insurance if I Can’t Get It From an Employer?

There are numerous dental plans available in most parts of the country that can be purchased by an individual. Most of these plans are some variation of a dental PPO in which you can access dental services from dentists that are part of the dental insurer’s network or discount plans that pay some percent of your dental bill at a dentist of your choosing.

One online source for information is the dental insurance section of eHealthInsurance.com. After answering a few simple questions and providing your zip code, the site will provide you with a list of options in your area including plan benefits, costs, and names of participating dentists.

If you belong to an organization such as a local business group, college alumni association, fraternal organization, or religious group, check to see if they can provide access to a group dental insurance plan. And, if you are a member of AARP, you can purchase one of two dental plans from Delta Dental, one of the largest dental insurers in the U.S.

Should I Buy Dental Insurance?

If you anticipate that your dental treatments will cost more than $500 per year, it might make sense for you to consider buying a policy or participating in a dental plan at work. If you and your family have healthy teeth and you are committed to oral health, you may not need dental insurance. Remember, however, that once you need fillings, teeth that need to be pulled, or a root canal, the bills can add up very quickly.

Except for accidental damage to a tooth, most dental disease can be prevented. The best way to avoid the need for dental insurance (and dental bills) is to brush your teeth after every meal, floss regularly, and see your dentist every six months for a routine exam and cleaning.

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