Several patients have been looking for dental insurance for the new year; so we thought it was time to write another blog about dental insurance.



Where to Look

The first place to look for dental coverage is through your employer. Often companies can get better rates for dental insurance for their employees because they contract for a large group of people.

If your employer does not offer dental insurance, or you are self-employed, you will have to search to find either a medical plan that includes dental, or a stand-alone dental plan. In years past, stand-alone dental insurance was difficult to find for individuals. These days, an internet search for dental insurance will bring up several different places you can shop online for dental insurance, such as eHealthinsurance.com. Additionally, with the implementation of the Affordable Care Act, you can enroll in stand-alone dental insurance through healthcare.gov.

What to Look For

With these and other similar websites, you will be presented with many different options for dental insurance. This may be a bit overwhelming, but our Evanston dentist office is here to help!

There are three types of dental insurance: HMO (sometimes DMO), PPO (sometimes DPO), and indemnity.

• HMO insurance requires you to go to an in-network dentist to get coverage. If you already have a dentist that you enjoy seeing, such as Dr. James or Dr. Robert, then it is best to contact your dentist to find out if they are in-network before purchasing an HMO insurance.
• PPO insurances allow more flexibility, as you can see any dentist that you would like to see. These insurance plans provide different coverage for visits to in-network and out-of-network providers.
• Indemnity plans allow for the most flexibility. These plans allow you to see any dentist that you would like to see without any changes in coverage.

Additionally, you should look at the maximum benefits. Unlike medical insurance, where you pay for your portion up to the maximum and then insurance covers everything after; dental insurance covers you at your contracted rate until you reach the maximum benefits, then you are responsible for the costs of any treatment above the maximum. So, a dental plan with a maximum of $500 wouldn’t cover as much as a dental plan with a maximum of $3,000.

Finally, look for an orthodontic option. Some insurance plans include an orthodontic option that you can opt in or opt out. If you are not planning on having orthodontic work – such as braces or Invisalign – you may opt out of this option to save yourself some money. If you are planning on orthodontic work or are unsure, it is best to opt-in. However, make sure it is a benefit and not a discount option. Your dental office may not participate in a discount plan, especially if they are out-of-network.

Things to Watch Out For

There are several different things to watch out for when you are purchasing dental insurance. The first thing to be aware of is a waiting period. Some insurance plans will have a waiting period before they will cover basic or major services. If you are looking for dental insurance because you have treatment you pending, look for a plan that does not have a waiting period.

Secondly, some insurance plans may have a ‘missing-tooth’ clause. This is similar to the ‘pre-existing condition’ clause in medical insurance plans. With a missing-tooth clause, insurance will not cover a replacement for a tooth that was missing prior to you having insurance with them. In some cases, the missing tooth clause is waived after a certain period of time. Check your plan to see if there is a missing tooth clause, and if so, when it may be waived.

Finally, most insurance plans have a ‘replacement’ clause. On average, insurance will cover a replacement for a crown or bridge once every five years. You should peruse your insurance plan and see what the specific limitations are on replacement of restorations. If you are planning on having major restorations replaced – such as a crown, onlay, inlay, or bridge – find out the date when the restoration was originally placed so you are prepared when your insurance requests the information.

Purchasing dental insurance can be overwhelming, but it doesn’t have to be. Take the time to learn what you are buying to make sure it works for your needs. If you have more questions about dental insurance, check out our other insurance blog posts. If you are purchasing insurance to use at our office, feel free to call our Evanston dental office with any questions. Our staff would be happy to help answer any of your questions.

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