Everyone loves a beautiful smile. But we often compromise our pearly whites because dental costs can get pricey, especially if you don't have dental insurance.
That's why many people look into dental discount plans as an alternative to help curb costs.
But there can be some confusion with dental insurance plans vs. dental discount plans. At first glance, they may seem like the same thing, but they're actually very different.
Dental insurance is a type of health insurance plan that covers a portion of the costs of your dental care. This can include coverage for preventive and basic dental care services - and even some major services.
Dental discount plans are an alternative to dental insurance. It's essential to understand that dental discount plans are not insurance. Instead, this plan connects you with discounts on specific dental services from certain dentists within the network. Other names for a dental discount plan are savings plans, discount plans, or access plans.
There are several types of dental insurance plans but the two primary types of dental insurance plans are as follows:
PPO dental plans
Dental Preferred Provider Organization (PPO) dental plans provide dental care for a fixed monthly premium. This type of plan allows you to visit any dentist within the PPO network for reduced service fees. You may go outside of the approved system, but your out-of-pocket costs will increase. This plan works well for those who want to see any dentist who takes their PPO plan.
DMO dental plans
Dental Maintenance Organization (DMO) plans allow you to see any dentist within the approved network for no fees or for a reduced cost. In some cases, the prices for a DMO dental plan are lower than a PPO plan. However, you can't go outside of the network to receive dental care. This plan works well for those whose preferred dentist is within the DMO network and who wants a lower fixed monthly premium.
Dental coverage depends on the plan and type, but often encompasses three areas: preventive, basic, and major care.
Preventive dental care includes diagnostic and preventive services like regular oral exams, teeth cleaning, and x-rays. It may also include fluoride treatments and sealants (plastic tooth covering to prevent decay). In many cases, dental plans include 100% of the cost of preventive care.
Basic dental care includes office visits, extractions, fillings, periodontal treatment (gum disease), and root canals. Your insurance company might pay anywhere from 60 to 80% of the cost for these services, with you covering the rest of the cost. But if you're paying a lower percentage of the costs, you may have a high-dollar copay.
Major dental care covers crowns, bridges, dentures, and inlays. Inlays are something between a filling and a crown: Your tooth might have extensive decay and need a more substantial filling, but it may not be in bad enough shape to require a crown. Meanwhile, crowns completely cover the tooth. Some dental insurance plans include root canals under "major" dental care, while others categorize them as "basic." The cost of major dental care is higher, and most insurance plans cover about 50% of the fee.
Simply put: Dental insurance offers people an affordable way to receive routine dental care and emergency oral procedures. Individuals and families who don't have dental insurance might visit the dentist less often. The result is less preventive care and early treatment for tooth decay and gum disease.
Choosing the right dental plan for you and your family may seem overwhelming. The National Association of Dental Plans (NADP) has put together a list of dental insurance words to help you figure everything out:
Copays: Fees you pay for covered dental treatments.
Deductible: The fixed amount you must pay each year before your insurance pays for any covered dental procedures. The good news is that dental deductibles are usually much lower than medical health plans.
Annual maximum: The most a dental plan will pay toward the cost of you dental services. If your treatment goes over this total dollar amount, the dental insurance won't pay the cost. Only 3% to 5% of people with dental policies reach the annual maximum each year.
Exclusions: Dental services that aren't covered by your insurance. If a service or procedure isn't on the list of covered services, you'll pay 100% of the cost. Cosmetic procedures like bonding or laser whitening are examples of standard exclusions.
Dental insurance premiums vary for each person. Some factors include:
In most cases, a higher deductible means a lower monthly payment. Or a higher monthly payment equals a lower deductible. For the most part, fixed monthly premiums range between $39 per month for an individual to $139 per month for a family. FAIR Health has a handy calculator for dental costs you can use to estimate the cost of specific dental services.
A dental discount plan works much like having a discount card at a grocery store or pharmacy. When you receive services, you show your card and receive a discounted price for dental work. There's no claim to process with the dental discount company. You pay the discounted fee, and that's it.
The programs can work for people who want to save on their dental needs, but they are more common for older adults. Discount ranges depend on the plan, but they're typically between 10% and 50%.
Unlike dental insurance, dental discount plans don’t have copays or deductibles. You receive a set discount on dental services only. Still, your out-of-pocket costs may be higher than your out-of-pocket dental insurance costs because the discount may be less than paying the copays, deductibles or coinsurance.
Some plans include complete coverage of preventive care, but this is a standard part of most dental insurance plans. (Reminder: Dental discount plans are not insurance plans).
Also, your dentist network may be smaller than with dental insurance, so taking advantage of the discount might be inconvenient.
Typically, your annual membership fee is about $150 per family - and you pay this fee whether you receive discounts on dental services or not. After you pay the fee, your costs depend on the dental services you need and the discount amount provided by the dentist.
Dental discount plans may be better if you want to supplement your current dental coverage or want a discount plan that includes a cost-benefit for cosmetic procedures. And they can be a good option if you know you're going to surpass your annual maximum on your dental insurance.
Dental insurance works for most people and operates much like health insurance: You have a more extensive network of dentists with dental insurance, and your out-of-pocket costs may be lower. You can also enroll in an individual dental plan in between jobs or while waiting for dental benefits to start at a new job. And you can cancel you coverage with a 30-day notice for most plans.
Some providers will accept both your dental discount plan and dental insurance. But others will allow you to use one, but not the other.
The best way to know if dental insurance is right for you is to shop around and compare plans.
Our plan comparison tool allows you to filter plans by insurance company, monthly premium, and annual maximum.
You can get a dental plan quote through our site with no commitment. The process takes just minutes out of your day: You enter your zip code, birthday, and gender to get a list of plans, plan benefits, and prices.
Healthinsurance.com LLC is a commercial site designed for the solicitation of insurance from selected health insurance carriers. It is not an insurer, an insurance agency, or a medical provider. You may obtain a complete list of available Medicare plans by contacting 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.