Dental Insurance Coverage

You only get one set of real teeth, so taking care of them should be a top priority. Dental insurance can give you the tools you need to protect your teeth and keep them clean and healthy. Read on for a comprehensive guide of dental insurance.

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Dental Insurance Basics

Dental insurance, like all insurance, is a deal that you make with an insurance provider. In exchange for a monthly premium (a payment that you make every month), they will cover some or all of the costs of certain dental procedures. Dental insurance will typically cover costs in 3 different categories:

  • Preventative Care: Care that is meant to catch problems before they happen and give you the tools to solve them yourself. This includes things like regular check-ups, batwing x-ray screenings, fluoride treatments for minors, etc. Many plans will cover 100% of the costs of preventative care.
  • Basic Care: Care that is beyond preventative, but not so extreme that it requires a specialist, multiple stages, or action on the patient’s part after the procedure. Most basic care isn’t more extreme or invasive than a tooth filling. 
  • Major Care: Care that is more extreme, complex, or otherwise costly than basic care. Procedures classified as major care fix problems that often could have been solved earlier for less money, but have advanced to the point that they require something more.
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Types of Dental Insurance

Dental insurance coverage plans fall into two major categories:

  • Provider Preferred Organization (PPO): PPO plans allow you to see any dentist within your provider network (the group of dentists that have been approved by your insurance provider to give dental care to their clients) for the cost of your monthly premium. If you want to see a dentist that is out-of-network, you can; the price will just be higher.
  • Dental Maintenance Organization (DMO): DMO plans, like PPO plans, allow you to see any dentist within your provider network for just the price of your monthly premium. However, unlike PPOs, DMOs will not cover you if you see a dentist that is outside of their network. Due to this restriction, the monthly premiums for DMO plans tend to be lower than for PPO plans.

Dental Insurance Pricing

One of the biggest factors that most people consider when they’re choosing a dental coverage plan is the cost of their monthly premiums. There are several factors that typically impact insurance premiums:

  • Location: Some areas are, simply put, more expensive than others
  • Dental Health: If you have a history of poor dental hygiene/need for surgery, then your premiums will be higher than someone that does not.
  • Level of Coverage Required: If you want a plan that covers most or all of the cost of basic/major care and want to visit out-of-network dentists, then your premiums will be higher than someone that only wants preventative care from a single or a few dentists.

Dental Coverage and the Affordable Care Act

Dental insurance for adults has been treated differently than dental insurance for children 18 and younger since the Affordable Care Act was passed in 2010. Under the ACA, dental coverage for people 18 and younger is considered an essential health benefit. Therefore, if you buy a health insurance plan for a child, then you also have to buy a dental insurance plan for them if the health plan does not include one. For adults, however, dental coverage is not an essential benefit.

If your yearly income is within a certain percentage of the federal poverty level, then you may qualify for a tax credit to help pay for your insurance premiums. If you have any of this credit left over after you pay for your health plan and your health plan does not include dental coverage, then you can use the leftover credit to help pay for a separate pediatric dental plan.

Apollo Will Find the Right Plan for You

Apollo Insurance Group has agents that are experts on dental insurance and are ready to help you find the right plan. Fill out our contact form to get in touch with an agent for a free consultation.

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