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Today, nearly 75 million Americans have no dental insurance, which prevents them from getting the dental care they need, when they need it. 

Undeniably, dental insurance premiums costing as much as $600 or more a year can represent a significant expense for any family – but they are still more convenient than facing thousands of dollars worth of out-of-pocket expenses when seeking dental care. 

So, how can you be sure to get the best value for your money when choosing your dental insurance cover? Here’s what you need to look for!

HMO vs PPO Plans: What Works Best For Your Budget?

Dental Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) are two of the most common types of dental insurance plans. Choosing wisely between the two is an important step to take to get the coverage you need while keeping your expenses within budget. 

Here’s an overview:

• HMO insurance – these plans have no deductibles and offer lower premiums, but you’ll need to afford co-payments as listed on your Schedule of Benefits for each dental treatment. 
• PPO insurance – PPO cover usually comes with higher monthly or yearly rates and requires you to commit to a deductible amount. But, when seeking dental care, you won’t have to worry about high out-of-pocket expenses. 

Check What Dental Treatments Are Covered

Knowing what your dental insurance plan will cover is key to taking the best care of your oral health and making sure that your needs are met. Most plans will cover at least:

• Routine check-ups and cleanings
• Emergency dental care
• Orthodontic (i.e.: braces) and other complex treatments, such as bridges and implants

Most dental insurance plans will also offer discounts for preventive care services that are critical to dental health. On the other hand, services like cosmetic dentistry and orthodontic (including teeth whitening) are considered non-essential treatments and are not covered by most plans. 

Pro tip – most insurance plans follow the 100/80/50 rule, by which your insurer will pay 100% of preventive care with in-network providers, 80% for basic services like fillings, and 50% for complex care like implants and root canals.

What Dentists Are Covered In-Network?

Whether you have a preferred dentist, or you are in the process of choosing a suitable provider, it is important to know what dentists in the area are covered in the network. 

Generally, PPO and HMO plans will limit coverage to dentists in their network, and, depending on your insurance plan, you might even be required to stick to a certain geographical area or franchise. 

The best way to proceed is to find a local dentist you can trust via recommendations, personal experience, or feedback. Then, ask about the type of providers they accept and compare dental insurance plans on marketplaces like Dentalinsurance.com. 

Pro tip: indemnity plans are among the most expensive ones, and they require you to afford the entire cost of your treatment before being reimbursed. However, indemnity insurance policyholders can find affordable care at in- and out-of-network providers. 

Consider Employment-Sponsored Dental Insurance

Over 80% of Americans have found themselves having to delay dental care because of their inability to afford related costs, even while knowing that postponing essential treatments will cost them more in the future. So, what happens if you can’t afford a dental insurance plan?

A valid option is to check whether your employer offers group dental insurance under programs like AARP or the Affordable Care Act. These plans might not be comprehensive or suit your specific needs, but they can offer some coverage for preventive and emergency care. 

Know Your Plan’s Caps and Limits

It is essential to be aware of your plan’s annual coverage limits and caps to know what treatments you can afford and how to plan major dental work, such as implants and bridges. Generally, dental insurance policies will cover a maximum of $1000 to $2000 a year, with annual deductibles ranging from $50 to $100. 

Familiarizing yourself with your policy is also important to understand waiting times and expected benefits. For some procedures, even common cones such as dentures, you might have to wait for up to two years and since these treatments fall under the category of complex care, they might only guarantee a 50% cover. 

Don’t Forget To Assess Your Insurer’s Customer Service – It Might Make a Difference When You File a Claim!

When choosing your dental insurance policy, it might be worth assessing a provider’s communication standards and customer service. The last thing you’ll want is to deal with inaccessible or unfriendly insurers while you are seeking emergency dental care!