Dental Insurance

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Dental Insurance

You have a lot of choices in securing dental coverage. Many insurance providers now have an optional dental benefit which can be added to your health policy, as well as stand-alone dental plans. Depending on your needs and budget, there are four types of dental insurance plans available to individuals in California, and a fifth choice, the dental discount card. Dental premiums usually vary from about $10 a month for a single person to $71 for a family.

The good news about dental coverage in California is that you have guaranteed acceptance. The provider cannot decline to cover you, even if you have dental conditions or need expensive procedures. The bad news is that the vast majority of plans have a waiting period. You must pay the premium for six to twelve months before non-preventative care is covered.

While this waiting period is frustrating, the dental plan providers enacted it because of customer abuse. Too many individuals took out coverage, immediately had several expensive procedures, and as soon as they reached their maximum benefit, canceled the policy. Dental HMO plans do not have waiting periods, but they do offer a limited number of dentists you can visit under their plan.

All the plans limit the maximum annual payable benefits, usually with a cap of $1000. They also limit how often they pay as well as how much they will pay for individual dental procedures.

Many dental problems are preventable and non-catastrophic when treated early, so most dental plans emphasize preventive procedures. Virtually every dental plan covers semi-annual cleanings and regular x-rays.

Making Choices

Some plans allow you to choose your own dentist. Others limit your choice in exchange for lower premiums. The two approaches are known as Open Panel (or Freedom of Choice) and Closed Panel. Open Panel allows covered patients to receive care from any dentist and also allows any dentist to participate. Under Open Panel, dentists may accept or refuse patients at their discretion.

Closed Panel allows covered patients to receive care only from dentists who have signed a contract of participation with the dental coverage provider. The provider contracts with a certain percentage of dentists within a particular area. Those dentists, in turn, agree to offer their services at a lower rate.

That number of dentists enlisted by a particular plan varies drastically by city, county, and region. We strongly suggest that you research which dentists in your area accept specific HMO plans before applying for coverage. Call your dentist's office and find out which plans they accept. You might even ask them which plan they prefer.

Read the fine print of your coverage. Along with waiting periods, benefit caps, and limited dentist selection, some providers require pre-approval of procedures.

Dental Health Maintenance Organizations (DHMOs)

These plans offer low cost or free preventative procedures and routine office visits, low co-pays, and selection of a single dentist from a list of approved in-network dentists providers. These plans often have caps on maximum annual benefits payable. These plans cost on average from $6 to $15 dollars a monthly.

Also known as capitation plans, DHMOs, are characterized by monthly premiums, free preventative or routine care, small co-payments for office visits, and a small network of selected dentists. The dentist is paid on a per capita (per head) basis rather than for the treatment provided. Contracting dentists receive a fixed monthly fee per patient regardless of whether treatment is performed. Patients may be referred to a specialist who also contracts with the plan, but they must pay in full if they use a dentist outside of the network.

DHMOs sometimes have initial enrollment fees.

Get a DHMO Dental Quote now.

Dental Preferred Provider Organizations (DPPOs)

These plans cost on average between $16 and $39 dollars a month. You can go to any dentist in the network. PPOs allow you to choose your own dentist. If your choice is contacted with the provider, you pay substantially lower fees. If they are not contracted with the provider, there is still some coverage, but you will pay more in deductibles and co-pays, and you may have to file claims on your own.

Get a free DPPO Dental Quote online.

Dental Indemnity Plans

Dental Indemnity Plans are one of the most flexible forms of dental coverage you can choose. You pay a monthly premium, usually between $19 and $25. There is no network, so you can go to any dentist. The deductible tends to be fairly high, and once you have paid that, the provider will cover a percentage of any further services. The provider usually covers preventative care at 100%, common restorative services at 80%, and major treatments like crowns and orthodontics at 50%. Most indemnity plans limit the annual benefit to $1000 and require a waiting period for non-preventative procedures.

Dental Indemnity Plans and Dental Discount Cards can be used together, allowing you to "stack" the benefits.

Get a Dental Indemnity Plan Quote now.

Direct Dental Reimbursement Plans

Direct Dental Reimbursement is not considered an insurance plan. Instead, it is a self-funded benefit plan usually offered by an employer or company sponsor. The patient pays the full cost of the dental treatment up front, submits the receipt for the treatment to the plan sponsor, and the plan sponsor reimburses them for the agreed-upon percentage of the costs, often 100%.

Typically, there are no monthly premiums. The cost of administrating the plan is covered by the employer or sponsor, and the benefit is capped at $500 to $1500 annually. The cap is determined by the employer. All types of dental care and treatments are covered by the reimbursement plan, and there is no waiting period. Direct Dental Reimbursement Plans are offered at the discretion of the employer or company, as they are the ones who foot the costs.

Get a Dental Reimbursement Plan Quote now.

Discount Dental Card

Discount Dental Cards, Plans, or Referral Plans, are not insurance plans. Consequently, they are not regulated by the California State Department of Insurance. The card issuer has a selection of dentists who offer services at a discounted rate. The patient typically pays an enrollment fee as well as a monthly premium for the use of the discount card. We strongly urge you to research the history, reputation, and legitimacy of the plan you are considering before providing them with any personal information.

The average cost for the discount cards are $5 to $10.

Some patients pay for both a card and an indemnity dental plan, allowing them to get a discount on services and a percentage of the services covered by the plan provider. The cards do not pay for any of the services a dentist may provide. They simply offer a discount on the standard service fees.

HealthInsurancePlus.com has decided not to review, offer, or recommend discount cards or discount plans. We have yet to find a discount card plan that actually meets our clients' needs. The card plans often generate confusion over what benefits are actually available, they do not cover any of the costs of dental care, and offer no help for major or catastrophic events.

Get a free Dental Discount Card quote.


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