Checklist: What to look for when selecting the right dental plan for you
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Wondering how to choose top dental insurance? What makes a dental insurance plan and insurance company “top rated”.1 If you’re shopping for an individual dental plan (as opposed to a group dental plan, e.g., through your employer), you want to ensure you’re getting the best dental coverage you can at a reasonable price.
Need dental insurance?
This article will help you do that by providing:
Top dental insurance plans: how they work
Like health insurance, dental insurance plans charge you a monthly premium. In return, the plan helps you pay for needed care. There are other similarities as well:
Most dental plans have a network of dentists
There’s a deductible – an amount you pay out of pocket before the plan pays for treatment
You pay for a portion of many procedures via co-pays (flat fees) or co-insurance (a percentage of the dentist’s charge)
There are also some important differences. The most common dental treatments – preventive checkups and cleanings – are usually covered without any out-of-pocket charge. The deductible is usually very low compared to a medical plan – around $25 to $100 per person annually.2 Also, most plans cap the total amount they will pay for care at $1,000-$2,000 per plan member per year.2 Any dental expenses over your plan’s cap (or maximum) will be your responsibility.
Two basic types of plans: DPPOs and DHMOs
The two most common types of plans are Dental HMOs (also known as Managed Dental Care plans) and Dental PPOs. A DPPO has a network of dentists, but typically lets you go out of network to see another dentist. You may want companies that offer a large nation-wide provider network, as your current dentist may well be “in-network” – check before you choose a plan.
Even though you can go out of network, it’s almost always worth your while to see an in-network dentist in a DPPO, because the insurance company negotiates discounted fees on your behalf. For example, if your dentist typically charges $100 for a filling, when he or she is in-network you may only be charged $60-$70 – even you haven’t met your deductible yet.
Even though can go out of network, it's almost always worth your while to see an in-network dentist in a DPPO, because the insurance company negotiates discounted fees on your behalf. For example, if your dentist typically charges $100 for a filling, when he or she is in-network you may only be charged $60-$70 - even you haven't met your deductible yet.
In the other type of plan – a DHMO – you have to see an in-network dentist. And because their networks are limited, you’ll need to check to see if your current dentist is included. The trade-off is generally lower costs and a simpler fee structure.
There’s also a third type of plan, called an “Indemnity” plan, which reimburses you for a portion of your dental care expenditures; however, those plans are somewhat harder to find and have the highest premiums of any dental insurance plan.
Three levels of coverage for three types of procedures
Many individual DPPO plans have a 100/70/50 coverage formula. That means it covers preventive care – checkups and cleanings – at 100% (you typically don’t even pay a deductible); basic procedures – like fillings and extractions – at 70%; and major procedures like crowns, bridges, and root canals at 50%. There are variations on this formula, and some procedures may be considered “basic” in one plan and “major” in another. Group plans (acquired through your work) typically offer a 100/80/50 coverage formula.
A checklist to help you select the top dental insurance that's best for you
This checklist shows some of the key features to consider when selecting a dental plan.
Plan feature | Considerations |
Cost | Look for plan that fits in your budget (e.g., some start at $20/month) |
Available plan options | Choose a tiered option (e.g., Bronze, Silver, Gold) based on the level of coverage you need |
Coverage: preventive services (e.g., checkups, X-rays, cleanings) | Look for 70% - 100% depending on plan level; payouts are limited by the plan maximum |
Coverage: basic routine services (e.g., fillings, simple extractions) | Look for 50% - 70% depending on plan level; payouts are limited by the plan maximum |
Coverage: major services (e.g., crowns, implants, periodontal work, orthodontia) | Look for 0% - 50% depending on plan level; payouts are limited by the plan maximum |
Waiting period: preventive services | Look for no waiting period (you get insurance benefits immediately) |
Waiting period: basic procedures | Look for 6 months |
Waiting period: major services | Look for 12 months (for tiers that cover major services) |
Nationwide network | The bigger the network, the higher the chance you can use your preferred dentist as they’ll be in-network and you’ll get the savings. |
In-network savings | Most insurers will provide an in-network discount (e.g., 36% nationwide discount calculated using 3 rd party data) |
Ease of claims | Look for a streamlined claims process (e.g., no need to submit a claim form with in-network dentists) |
Guaranteed acceptance | Instant customer approval for all plan levels |
Increasing cap | The “cap” or maximum increases each year for most plan levels |
Other things to consider when looking for a top-rated dental plan
We’ve discussed a number of key dental plan features to help you understand how they work. But what factors are most important in choosing one plan over another? Here are some things to consider.
Do you have a dentist you like? Start by looking for an insurance company with a broad nationwide network, then ask your dentist if he or she is in that network.
How much will you save vs. regular rates? Look for the plan to state what level of discount you’ll get for services provided by an in-network dentist. The bigger the discount, the better.
Do I have to file claims forms? Assuming you don’t like to do paperwork, make sure to go with an insurance company that doesn’t make you file claims forms when you use an in-network dentist.
What level of care do you and your family members need? Remember that there are waiting periods for major treatments. If a family member has a preexisting condition and needs a crown right away, it won’t be covered. However, if you know that your spouse has had dental issues in the past, or that your children are likely to need braces in the future, then it pays to look ahead and get a plan that will provide the appropriate amount of coverage after the waiting period ends.
Are you willing to give up some convenience in order to save more? If the answer is yes, consider getting a DHMO plan. The network will be much smaller than a good DPPO plan, which means you probably won’t be able to see your current dentist – and you may need to travel farther to find a dentist in the plan.
Frequently asked questions about top-rated dental plans
Is dental insurance worth getting?
If you never go to a dentist, it’s clearly not worth the expense. But top dental insurance, like many other kinds of insurance, can help reduce your financial burden if you’re hit with the cost of a major treatment like a bridge or root canal. Another benefit to having dental insurance is that it makes basic and preventive treatments like cleanings and fillings much more affordable. That encourages people to treat problems earlier on – and can help them save money afterward. For example, a cavity filling typically costs $90-$250; but left untreated, average treatment costs can shoot up to over $1,000 if you need a root canal and crown.3
What is the top-rated dental insurance plan?
There is no official rating of top dental plans that we are aware of. We suggest reviewing the features offered by various insurance companies, to see which plan provides the best fit for your needs.
How much does dental insurance cost?
Costs vary by plan and by state.
What factors should seniors consider?
All of the factors that are important to younger people are just as important to seniors when it comes to comparing dental plans. Think about the amount of care you need, the size of the network (and whether your dentist is in it), coverage levels, discounts, convenience, and premium cost. The checklist in this article can help simplify your choice.