A great number of people in the U.S. have realized the value and significance of dental insurance plans. Dental benefits allow them to reduce their out-of-pocket costs for oral care and also increase the likelihood that they will seek dental care if required. According to the National Association of Dental Plans, individuals having dental benefits are likely to visit the dentist and have greater overall health. With an increasing number of people realizing the value of dental insurance, around two-thirds of Americans have access to private dental insurance whereas many people obtain dental coverage through government programs like Medicaid, the Children’s Health Insurance Program, Medicare Advantage, and Indian Health Services. Even some short-term plans also give the option to add value-added dental insurance coverage while purchasing these plans at the time of application with no additional steps.
Dental Insurance Benefits
Dental insurance benefits not only reduce the out-of-pocket expenses for dental services but its benefits are divided into the following three categories:
- Preventive Dental Benefits include dental care like cleanings, routine exams, and x-rays.
- Basic dental benefits include things like fillings, tooth extractions, and root canals.
- Major dental benefits include dental services like implants, bridges, oral surgery, and crowns.
Most of the dental plans provide coverage for preventive care at near 100%, and basic care is covered at a higher percentage than major care. Members of the dental plans can immediately access preventive care benefits, though some of the dental plans have a waiting period before starting the other types of care.
How Dental Insurance Works?
Dental insurance plans work much like health insurance plans where members are required to pay a monthly premium to remain covered. The dental plan benefits kick in as soon as the members meet the plan’s deductible. Members are also required to share costs with their insurer while paying coinsurance for the received dental care or pay a copayment on visiting the dentist. Like health insurance plans, members of the dental plans also need to visit a provider who accepts their coverage and if their dental plan has a network, then they should visit in-network providers to avail the best rate.
Members of the dental plans on arriving for the appointment have to present their dental plan ID card. The dentist will submit the claim to their insurer. The insurer will pay the dental care provider for the part covered under the plan, and the dentists will bill the insured for their share. Dental plans come with a cap on the amount which the plan will pay for the covered dental services, and if the insured needs additional dental care after their plan meets their maximum amount, then the insured will be billed for 100% of the cost.
Types of Dental Plans
Some of the dental plans come included with provider networks in which specific dentists contract with a plan to provide dental services to its members. Dental plans that come with a network require members to seek in-network care.
Dental plans that don’t come with a network are known as indemnity or fee-for-service plans and members of these plans can visit any dental care provider. This means members are free to keep their preferred dentist, though people are likely to pay a higher premium for this coverage.
Dental plans with provider networks are dental HMOs and dental PPOs and a network plan favors in-network care.
PPO Dental Plan
People enrolled in PPO dental plan will enjoy higher benefits for in-network providers, though people can choose an out-of-network provider but they will require to pay more for the care.
HMO Dental Plan
With an HMO dental plan, people are mandated to seek in-network care or pay 100% for out-of-network care.
Does Medicaid have Dental Insurance Benefits of Not?
It is mandatory for all states to provide dental benefits to children covered under Medicaid or the Children’s Health Insurance Program(CHIP). These programs should include coverage for children who need dental services for infection, pain relief, teeth restoration, and maintenance of dental health. However, for people older than 21 years of age, every state decides whether dental benefits for adults will be included in their Medicaid program or not. Most of the states include emergency dental services for adults but comprehensive dental coverage if offered by less than half dental plans. Thus, adults enrolled in Medicaid will need to check about the dental benefits included in their state’s program. If it is not included, then they may have to look into a private dental plan. Some of the other ways to obtain affordable dental care include clinical trials, dental schools, free or reduced-cost clinics operating through their state or local health department.
Do Medicare Plans have Dental Benefits or Not?
Traditional Medicare plans do not include dental services, with the only exception of some dental services that are covered by Medicare Part A when the beneficiaries are in hospital. Some of the Medicare beneficiaries may have access to dental coverage through Medicare Advantage plans and other sources but nearly two-thirds of the Medicare beneficiaries do not have dental coverage.