Preventive Pediatric Dental Care May Be Covered In Full But It Doesnt Have To Be
Its important to understand that services we typically think of as preventive dental treatment are mostly not included in the specific list of preventive services that the ACA requires plans to cover for free for all children. The only services related to dental care on that list are fluoride supplements for kids without access to fluoride in their water, fluoride varnish for infants and children, and oral health risk assessments for young children. So things like dental cleaning and x-rays do not fall under the umbrella of free preventive care under the ACA.
If you buy an exchange-certified stand-alone pediatric dental plan, theres a good chance those benefits will be covered in full or with relatively low cost-sharing . If you have embedded pediatric dental, its up to the carrier to design the benefits, but you may still find that you have access to routine cleanings for your kids at little or no cost.
State-based exchanges can implement their own requirements though. Covered California is an example: All of their health plans include pediatric dental, and preventive dental care are covered in full, even if the member has not met the deductible yet.
Do I Really Need Dental Insurance
I wish there was a one size fits all answer.
Unlike health insurance, which many employers offer, dental insurance is optional as the benefits may not be worth the cost.
Dental insurance can save you big if you need orthodontic work or have an unexpected emergency procedure like a root canal.
If you only go one or two times per year, dental insurance isnt nearly as important.
Compare Dental Procedure Costs
You can compare the out-of-pocket costs for a routine cleaning and x-rays to the cost of dental insurance and benefits.
If you dont use the dental insurance to the fullest, the monthly premium may be way more than the treatments you receive.
For example, lets say you only go twice a year for basic teeth cleaning procedures.
The cost is around $80 dollars per visit for a total of $160. But the average dental monthly premium is $30 or $360 annually. Clearly, dental insurance is not worth the costs.
Of course, you cant plan for unexpected events like root canals or crowns. Dental emergencies can happen unexpectedly.
Having the dental insurance can be worth it to avoid a financial emergency.
Senior Dental Insurance
Dental insurance is usually a great option for children and seniors.
Medicare is very limited with their choices and root canals or dentures can be very expensive. Dental insurance for seniors can offset the insurance gap.
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Adult Dental Plans Through Acas Marketplace
For the most part, the Affordable Care Act didnt help expand access to adult dental coverage. Dental insurance is generally available through the health insurance marketplace, but only during open enrollment or a special enrollment period, and often only in conjunction with an ACA-compliant health plan.
Heres more about adult dental coverage through the marketplace:
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Why Does My Dental Insurance Have A Waiting Period
Dental insurance waiting periods help insurance companies keep costs low. Establishing a waiting period helps prevent consumers from purchasing plans only when they need extensive work they cant afford on their own, then dropping their coverage. Waiting periods for major work help encourage regular exams and help keep membership high enough for premiums to provide coverage for those insured.
What Is Dental Insurance With No Waiting Period
Many dental insurance policies impose a waiting period of months or even years before certain services are covered, meaning you might have to choose between putting off essential procedures or paying the full cost out of pocket. Dental insurance with no waiting period begins coverage on day one so you dont have to wait.
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Can I Get Cost Assistance On Dental Coverage
Cost assistance only applies to major medical coverage and not dental plans. However, if you get a marketplace plan that includes dental insurance, it will only have one premium which Premium Tax credits can be applied to. You cannot apply Tax Credits to a stand-alone dental plan. CHIP includes dental insurance.
Best For Veterans: Metlife
- Coverage Limit: $1,000 to $3,500
- States Available: 50
If youre receiving VA health benefits, MetLifes VADIP dental insurance plans offer no waiting periods alongside other perks for veterans and is the best we found here for veterans.
Affordable coverage for veterans and their dependents
500,000 provider network access locations
Annual maximums as high as $3,500
Must be enrolled in the VA health care program for the veterans dental plan
Only two policy options available
24-month waiting period for orthodontics
Insurance provider MetLife enforces waiting periods for most of its policies, but these are waived for retired service members through the Veterans Affairs Dental Insurance Program . Open to any veteran enrolled in the VA health care program, these dental policies are available at two coverage levels: Basic and High. For the standard plan, a single veteran will be charged between $28.89 and $33.80 a month. For the high plan, a single veteran will be charged between $61.14 and $71.53 a month.
MetLife is a global insurance provider offering insurance in many lines and has been doing business since 1868. The company holds an A+ rating from AM Best, indicating solid financial strength. MetLifes dental network for veterans includes over 500,000 participating locations, one of the largest in the country.
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Best For Root Canals: Humana
- 5 programs, 1 for veterans
- $1,000 to $1,500 on annual maximums
- Available in all 50 states, the District of Columbia, and Puerto Rico
We chose Humana because you are covered on your first effective date. Also, as you subscribe longer, you get more coverage for root canals up to 50%.
No waiting periods on most plans
Root canals covered on day 1
Substantial nationwide network of 270,000 providers
Not all plans cover major services like root canals
First year coverage on root canals is only 20%
Headquartered in Louisville, KY, Humana was founded in 1961. It’s a large, well-known brand for insurance with a wide range of insurance products and a substantial nationwide presence. It also has top ratings from A.M. Best. Policies are available direct and through employer groups.
We like Humana’s dental plans with no waiting periods for the best for root canals category because their Loyalty Plus PPO has no waiting periods and covers root canals at 20% on day 1. That coverage increases over the next three years until it reaches 50%. Also, waiting periods might be waived on Basic and Major care for the other plans they have available if the new subscriber shows similar dental coverage for the previous 12 months. In addition, you can choose any dentist.
Does Dental Insurance With No Waiting Periods Cut Costs
You might think that buying dental insurance with no waiting periods would be the best way to reduce your oral care costs.
After all, paying a small monthly premium and getting an enormous immediate benefit in return should be the ideal way to make dental work more affordable.
Guess again. The issuing companies have no interest in trading hundreds of dollars in exchange for thousands in instant claim payments. Would you?
Therefore, be prepared to practice delayed gratification although a new policy could pay off in the end if you need significant dental work in later years.
See how the numbers work for a real-world PPO policy. Then, explore other designs and alternative approaches to making dental work economical.
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How Much Is Dental Insurance
Dental plan premiums range from $17 to $96. Cost varies per plan type, coverage level and state of residence.
The plans with the lowest premiums cover preventive procedures and offer minimal or no coverage for basic and major services. On the other hand, the plans with the highest premiums tend to have shorter or no waiting periods, high annual limits and comprehensive coverage for preventive, basic and major work.
If comprehensive dental benefits are cost prohibitive for you or your family, consider low-cost alternatives to dental health insurance such as dental school clinics and state assistance programs.
Cost of common dental procedures
The cost of dental care depends significantly on the provider, the location and whether the patients insured.
To give readers a general idea, we looked at the average cost of common dental procedures in the 2020 Survey of Dental Fees published by the American Dental Association . Then, we calculated how much that procedure would cost with an insurance policy that covers 100% of preventive care, 80% of basic work and 50% of complex procedures.
Heres what we found:
|Cost without dental insurance|
More Expensive Plan Vs Out Of Pocket Dental Expenses
Consider a more expensive plan with no waiting period if your child needs to get dental treatment quickly. Look at the services your child needs and the cost of the treatments. Compare the out-of-pocket costs of treatment with potential dental insurance plans.
Treatments that cost more than the annual premium of an insurance plan for your child may make a more expensive plan worth it. For example, your child may need a procedure that costs $500. You find a childrens dental plan for $350 per year, with no waiting period, that would cover up to $450 of the service. Your out-of-pocket cost would be $350 for the plan and $50 for the service, or $400. This is less than the full cost of treatment.
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Orthodontic Insurance For Children
Many dental insurance plans will cover orthodontic insurance for children under 18 if braces are considered to be medically necessary. Make sure to read the fine print in your plan, and talk to your provider. Keep in mind that straightening teeth to improve the aesthetics of a child’s smile will probably not be covered by their dental insurance plan.
Is Dental Coverage Required Under The Aca
Yes, for children but not adults. After Jan. 1, 2014, all individual and small group market plans both inside and outside the exchange must be certified as qualified health plans except for stand-alone dental plans. QHPs must provide all essential health benefits. Pediatric oral health services are included in the 10-category EHB package and must be offered.
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Orthodontics For Kids Are Also Covered By Spirit Dental
As your kids permanent teeth come in to replace the baby teeth, you might notice that they arent growing properly. For example, the teeth might be crowded or crooked, or there might be too much space between them. Beyond that, the bite might not be in proper alignment if theres an overbite or an underbite. In all of these cases, failing to fix the problem might lead to complications in the future, and your child wont have the lovely smile that they deserve.
With a Spirit Dental plan, you can rest assured that, if your child needs braces, youll be covered. And thats important because, on average, braces could cost anywhere from $3,000 to $7,000!
If youre interested in learning more about dental insurance for childrens orthodontics, .
Types Of Dental Insurance Plans
The three types of dental plans on the market today are dental preferred provider organization plans, dental health maintenance organization plans and fee-for-service plans:
Dental preferred provider organization
DPPO plans have a wider network of dentists, and patients have more flexibility when choosing their doctors. You can see providers both in-network and out of network, but youll find the best rates within the dental provider network.
This flexibility comes with a higher price tag premiums for DPPO plans are more expensive and have higher out-of-pocket costs.
Dental health maintenance organization
A DHMO plan works within a dental provider network. Theres a fixed copayment for each visit, premiums are more affordable and there are no annual maximum limits.
Members of a DHMO plan have a smaller provider network to choose from, and theyll also need to select a primary care dentist from the plans network. Lastly, theres no out-of-network coverage, and seeing a specialist requires a referral.
Fee-for-service plans pay a flat rate for eligible services. This plan type allows greater flexibility because patients can visit the provider of their choice.
On the downside, out-of-pocket expenses are higher. Patients can either make a copayment at the dentists office or pay upfront and then file a claim for reimbursement with their insurance provider.
Dental discount plans
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Does Insurance Cover Braces For Adults
If you need dental insurance with orthodontic coverage for adults, there’s some good news. Comprehensive dental insurance plans may cover orthodontic work for adults if it is for health reasons. Insurance plans won’t cover braces if it’s purely cosmetic. If your dental insurance doesn’t cover braces, consider purchasing a supplementary orthodontic plan, or enrolling in a dental discount plan.
Best Budget: Metlife Takealong Dental
- Annual maximums range from around $750 to $2,000
- Available in all 50 states and the District of Columbia
We chose MetLife TakeAlong Dental because the premiums are reasonable: Preventive, Basic, and Major coverage are the same as other providers.
No waiting periods on Preventive care
High Plan offers $2,000 in annual maximums per subscriber
Has generous benefits for routine dental care and comprehensive services
Waiting periods on Basic and Major care services
Deductibles on High plan are higher at $75 and $225
MetLife has been providing insurance products for over 152 years. Underwritten by the Metropolitan Life Insurance Company in New York, MetLife provides benefits to 20 million people. MetLife also has high ratings with J.D. Power and Associates and AM Best and is available in 50 states and the District of Columbia. It offers benefits through employers and direct to individuals.
The MetLife TakeAlong Dental plans give you 100% coverage for Preventive care from day one and six months for Basic care. Like PPO plans, you can pick your dentist the coverage is the same in and out of network. The higher the plan level, the more coverage you have for Basic and Major care. The highest level plan has a lower deductible than the low option.
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Is It More Expensive To Use Dental Insurance With No Waiting Period
It depends on the category of care you seek. For example, it is not more costly to get preventive care, as dental insurance policies with no waiting period usually provide these and pay 100%. However, if you have Basic or Major care needs, you might pay more in the first year or two than you would by year three. That’s because many policies will increase coverage the longer you subscribe. For example, many United Healthcare plans pay a smaller percentage on day one of coverage than they do a year later.
Best For Basic Coverage: United Healthcare
- 10 plans, 8 with no waiting periods
- Maximums in some plans range from about $1,000 to $3,000
- Available nationwide
We went with United Healthcare because it has eight dental insurance plans with no waiting periods for preventive care and basic. Also, the high-end plans have generous coverage maximums at a reasonable premium per month.
No waiting period for Basic care
No waiting period for Preventative care covered at 100%
Shorter waiting periods on Major coverage for some plans
Some of the plans only cover
Basic care at 35% on day 1
Plan availability varies by state
United Healthcare is a prominent nationwide brand for insurance with a top rating from A.M. Best. It insures 30 million people nationwide and is underwritten by the Golden Rule Insurance Company. The company has a robust network of providers of roughly 182,000. United Healthcare’s dental plans are available in most states through employers and direct, but the plan features may vary based on where you live.
There are no waiting periods on Basic and Preventive care, generous annual maximums on the higher levels, and shorter, six-month waiting periods for Major coverage on many of its plans. In addition, several plans cover preventive at 100%. There are also no age restrictions on coverage. Moreover, the premiums are lower than we expected. For example, the monthly premium for a woman under 50 in California ranges from $24 to $64, depending on the plan.
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Buying Adult Dental Coverage On
If youre shopping outside the exchange and you have children in your family who will be on the dental plan with you, keep in mind that the ACAs pediatric dental benefits do not have to be offered on plans that you purchase outside the exchange.
If youre only buying coverage for adults, the overall benefit options will be fairly comparable on-exchange and off-exchange. But if your plan will also cover children, the benefits that will be provided to the children via an on-exchange dental plan will be much more robust than the benefits that will be provided to adults .
As noted above, dental insurance can only be purchased through the exchange during open enrollment or a special enrollment period. And in the majority of the states, it can only be purchased together with health insurance which means the exchange might not be a good solution if you only need dental insurance.
For example, maybe you work for an employer that provides medical coverage but not dental coverage. Or maybe you have Medicare and thus cannot buy an individual market plan .
Fortunately, there are off-exchange dental plans available nationwide, year-round, without the need for a qualifying event. Depending on where you live, youll generally find that different insurers offer plans on-exchange and off-exchange, so its worth comparing both options .