Dental insurance

Dental insurance helps people keep their mouths and gums healthier by making regular checkups more affordable and helping to pay for other dental treatments and services. Preventive care visits are often covered in full or with just a small copay. That helps encourage regular cleanings and helps catch minor problems while they are easier (and less expensive) to treat. Coverage for other treatments and procedures varies; some plans focus on basic care (like fillings and extractions) and others will cover major procedures like root canals and crowns.

Different dental plans from different insurance companies offer various combinations of benefits, features, and options, so it can pay to shop around. But generally speaking, the best dental insurance for individual and family needs is a plan that meets their needs and supports dental health by letting them see a dentist they like, with coverage for the treatments they're likely to need, at a price that fits their budget.

Most dental policies are dental PPOs.⁸ These plans have a network of dentists who agree to provide care at a discounted rate. When you go to an in-network dentist, your out-of-pocket cost for dental treatment will likely be less. With a dental PPO plan, you may also see a dentist who isn't in the network; however, your out-of-pocket costs may likely be higher. Dental PPO plans generally let you see a broader range of providers than a dental HMO, but dental HMOs typically have lower premiums and fewer out-of-pocket costs. With DHMO you must obtain services from a designated Primary Care Provider (who is in network) in order to be eligible for benefits.

There is no set standard for what constitutes “basic” dental coverage, and different dental insurance plans cover different procedures. But generally speaking, a basic plan will cover standard preventive dental care — checkups, cleanings, routine x-rays, and sometimes, fluoride treatments. Insurance companies such as Guardian also provide more comprehensive plans that can cover other things that contribute to oral health:

• Basic care: Fillings, extractions, and other minor services

• Major care: Root canals, crowns, bridges, and dentures

• Orthodontic treatment: Braces and other types of teeth aligners

Each dental insurance plan will have its own list of covered and non-covered procedures. Generally speaking, the most inexpensive basic plans will have a shorter list of covered procedures (typically for preventive care) with more exclusions, and the more expensive comprehensive plans will cover more procedures with fewer exclusions.

Yes, as with health insurance, you can buy dental insurance as an individual or family if benefits aren't available through your employer. Dental insurance cost doesn't have to be a barrier: a variety of affordable dental plans are readily available, and you don't need to go through an insurance agent -- it's easy to buy directly online.

According to HHS.gov, states are required to cover dental services for people with Medicaid under the age of 21, as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. However, states may or may not elect to provide dental benefits to their adult Medicaid-eligible population, and fewer than half of states provide comprehensive dental care.