In addition to deductibles and annual maximums, most dental plans require cost sharing such as copayments or coinsurance. These amounts are typically only applied after the plan has paid for most of the care needed in a given year. It’s essential to fully understand the terms of a full-coverage individual dental plan before purchasing one. This includes understanding what the plan covers, its premium (monthly fee) and deductibles.

In-Network Dentists

A dental network is a group of dentists contracted with your insurance company to provide care for a set fee. Dentists who participate in a network are considered “in-network,” and those who do not are considered “out-of-network.” In-network dentists have agreed to discount their fees for patients with individual dental plans so that the insurance company will pay them at a pre-negotiated rate. In-network dentists typically also accept the employer’s “table of allowance,” which estimates how much a procedure will cost the insurance carrier. Managed-care plans such as Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO) require you to see in-network dentists unless you meet the plan’s deductible or have an exception that allows you to go out-of-network with reduced coverage. 

Preventive Care

As with any insurance, dental plans vary widely in terms of coverage amounts, deductibles, copays, and maximum annual benefits. Generally, managed-care dental plans offer lower out-of-pocket costs than traditional insurance because they negotiate reduced fees with participating dentists, and most have a pre-determined copayment for procedures or services. In addition, dental HMOs and DHMOs tend to have lower premiums than dental PPOs if the coverage amounts are similar. Conversely, a more extensive annual benefit limit plan may have higher monthly premiums. Also, if the plan lists an annual maximum, it refers to the top amount the plan will pay for all services during one year. After reaching this maximum, you must pay out of pocket for any services received, though preventive care is usually fully covered even before the deductible is met. Lastly, you have full coverage if a plan has no annual maximum. This is a rare find, especially for individual plans. A comprehensive individual dental plan includes coverage for primary restorative care, like fillings and tooth extractions, as well as major restorative procedures, such as crowns, bridges, and dentures. These procedures are expensive, and dental insurance plans usually have a low annual benefit limit. 

Primary and Major Restorative Care

When choosing a dental plan, pay attention to deductibles and annual maximums. Those are the amounts that your dental insurance provider will agree to cover over a plan year, and once you reach this amount, you’ll be responsible for any remaining out-of-pocket costs. Depending on your plan type, you may encounter other cost-contributing elements like copays and deductibles. Some plans require a deductible for every service received before coverage.

Dental Implants

Dental implants are the gold standard for replacing missing or failing teeth. They offer better function, aesthetics, and health benefits than alternative solutions such as dentures or bridges. However, not all dental insurance policies cover them, so when choosing a comprehensive individual dental plan, consider the availability of coverage for dental implants. When looking for a dental plan that offers implant coverage, carefully review the plan details and compare specific policy provisions including annual maximums and coverage percentages. Also, consider your overall dental health needs and cost-benefit analysis, including other treatments and preventive measures the plan may cover besides implants. Dental insurance typically runs by benefit year, so you should schedule your implant treatment when your benefits reset. Also, be aware that a deductible will apply and that many dental insurance plans have coinsurance. These costs will be incurred in addition to any copayments you may have to pay at the dentist. The amount of the deductible and coinsurance will vary between dental insurance companies.

Preventive Dentistry

Full coverage dental insurance allows you to get preventive services, like regular cleanings, exams, and x-rays, from in-network dentists with low or $0 out-of-pocket costs. These services can help your dentist identify and treat problems in their early stages when they are much less expensive. Experts recommend that adults visit their dentist for preventive care at least twice yearly. However, many people should see their dentist more often. Poor oral health is linked to other diseases and conditions, such as heart disease.