May 7th, 2021
July 8th, 2020
Even though dental care isn't as expensive as health care, it can still be pretty pricey. Dental insurance and dental discount plans can help you manage those costs when they come up. So, the question is: which is best? To answer this question, you have to understand the differences between dental insurance and dental discount plans. You also have to consider what your dental needs and financial situation look like. search Highlight: Dental insurance is the better buy. Differences between discount plans and insurance go further than how the plans work. Regulatory and oversight differences make dental insurance a safer purchase. Skip to "Should I get dental insurance or a dental discount plan?" to get the details. What is dental insurance? Dental insurance gives you access to discounted dental rates and cost-sharing benefits. Dental insurance usually covers preventive care at high rates, or even fully. Other types of treatments are categorized as basic and major restorative services. Coverage rates for these vary, but are typically higher for basic services than major services. Some dental insurance plans cover cosmetic dental care or braces, but these services aren't covered by typical dental insurance plans. It's common for dental insurance plans to exclude coverage for pre-existing conditions, so if you're shopping for a plan because you need a root canal, you may have to do more digging to find a plan that will cover a pre-existing condition. Dental insurance plans also have networks of care providers. With a Dental Health Maintenance Organization (DHMO) plan, the insurance company will only cover dental care received from dentists in their network. A Preferred Provider Organization (PPO) plan gives you more flexibility when choosing a dentist because it offers both in- and out-of-network care. Keep in mind that coverage rates for out-of-network care are usually lower than for in-network care. With a dental insurance plan, you'll pay a monthly premium and out-of-pocket costs. Dental plans have an annual deductible. Once your out-of-pocket expenses have hit the annual deductible, the insurer will take more responsibility for your dental costs up to a certain point. Dental insurance plans have annual maximum benefits. This is the most the insurer will pay towards your out-of-pocket in a given year. Once the insurer has paid out your annual max, you'll resume full responsibility for your out-of-pocket costs. Most plans have a per person annual max. It's common for dental insurance to have waiting periods, especially for basic and major restorative services. These can be anywhere from three months to a full year depending on the plan. If you had comparable coverage prior to enrolling in a plan, you may be able to have the waiting period waived. Some dental plans have no waiting periods. These plans usually have increasing coverage rates for services the longer you keep the plan. These increasing coverage rates usually max out after the second year. You may also end up paying higher premiums for immediate coverage than for a plan with a waiting period. Keep in mind that these plans may not cover pre-existing conditions. Read "Dental Insurance with No Waiting Period Guide: What You Need to Know" to learn more and get expert insight on these plans. When you evaluate a dental insurance plan, look at the covered services, premium, network, deductible, cost-sharing rates, and annual maximum benefit. Understanding how the full insurance plan works together will help you determine the value offered by the plan and whether it's a good fit for your needs or not. What are dental discount plans? When people refer to dental discount plans, they usually mean plans offered by a third party. Some dental offices offer their own discount programs to patients. Remember: dental discount plans and programs are not the same as insurance. Third-party dental discount plans Dental discount plans are also called dental savings plans. These plans have set fees for dental services. The companies have contracted with dentists who accept the discounted rates for their services. If you get a dental discount plan, you'll pay a small premium and then be fully responsible for your out-of-pocket costs. You don't have to worry about waiting periods. Discount plans tend to be explicit about what each covered service will cost you out-of-pocket, which is nice because sometimes insurance plans can make costs difficult to estimate. Keep in mind that dental discount plans advertise steep discounts, which means that it may be difficult to find a dentist in your area who accepts your plan. Before you enroll in a plan, see which dentists accept your discount plan near you. In-house dental discount programs Your dentist may offer some in-house dental discount programs with similar discount percentages as those offered by a third-party plan. If you have a good dentist whom you trust, these in-house programs can be a better alternative to a dental discount or dental savings plan from a third party. Bruce Hogan, Software Pundit CEO, recommends considering the discount rate, covered services, and subscription fees when considering an in-house dental discount program. "How much of a discount the plan provides and which services are included. Dental membership plan discounts range between 10–40 percent of common services. Most plans include basic cleaning and some additional services. Some practices might offer family plans for broader coverage. How much you have to pay upfront to begin receiving services. Some discount plans are paid annually, which means you have to pay 12 months of fees to begin receiving services. Others are paid monthly, which allow you to pay significantly less to begin receiving services." Keep in mind that the subscription fee pays for the discount. In some cases, you may be better off planning for your dental expenses and setting aside money to pay for these costs. Should I get dental insurance or a dental discount plan? Now to the big question: which is better — dental insurance or a discount plan. It boils down to your budget, dental health, and what risks you want to assume. Whichever direction you go, you'll want to find a trustworthy dentist to ensure that you receive quality care and medical advice. Reasons to choose dental insurance Between the two, dental insurance is the better option, especially if you need a higher amount of dental care because it usually offers more protection for out-of-pocket costs through its cost-sharing structure. "If you need a lot of dental work done on your teeth, it would be a better option to go with a traditional dental plan," recommends Dr. Jacqueline Fulop-Goodling, D.M.D., P.C. If you can afford a traditional dental insurance plan, it's also the safest option because you'll benefit from the insurer's internal review and government regulation. Even though insurers are notorious for difficult pre-authorization processes and issues with claims, these penny-pinching practices have a side effect of protecting patients. "In looking after the expenditure of its money, the insurance company indirectly looks after patient spending. Please don’t conflate this as the goodwill of the insurance industry or any genuine concern for patients. Their primary obligation is fiscal returns for their investors. Dental services that are determined to be of limited value, unethical, or dishonest will be denied for payment. Dental services that are outside the range of covered benefits, but may be of value to patients, also will be denied," writes Michael W. Davis, DDS in "Misrepresentations to Consumers: A Dark Side to Dentistry". Insurers are also subject to government regulation and oversight, which is another layer of protection for policyholders and patients. While dealing with insurance companies can be a headache at times, your risk of receiving unnecessary dental care is much lower. Reasons to be cautious about dental discount plans While it's a good practice to explore all of your options, whatever kind of dental discount plan you consider, you need to realize that there is less regulation on these programs and the kind of care you receive. It's even more important with these plans to see a trustworthy dentist. "True insurance plans are required by state statutes to meet specific requirements: Valid insurance plans must be registered w/ the state’s insurance commission, and are regulated by the same authority. The state insurance commission has oversight authority with insurance vehicles. They have the power to accept public complaints, preside over hearings, and take a variety of actions in the public interest depending on state law. Valid insurance companies are also required to set aside a 'claims reserve.' The amount or percentage varies with the state statutes. None of that is true for discount healthcare plans. They have no state or federal governmental oversight and no claims reserve. It’s the wild west," says Davis. Third-party dental discount plans are not permitted in some states due to legal restrictions. Other states do regulate these plans, but not every state does. These plans don't just lack government oversight, they also don't have the same review process that insurers have when processing insurance claims. This is the case with in-house dental discount programs. "In-house dental discount plans completely lack any oversight of a state insurance commission, and often very importantly, the insurance company’s internal review process. Insurance companies don’t like to pay out on billings, and especially fraudulent billings. Their claims review process is targeted to pick up “red flags” in provider billing errors, abusive billings, and fraud. Thus, with an in-house discount dental plan, the patient must place complete trust in the facility providing services and the charges for those services. There exists no outside oversight. Patients are fully on their own," says Davis. In addition to the lack of oversight, you'll also limit your choice of dentists and risk receiving dental care you do not need. "Almost no dental clinics accept the plans because remuneration under the plan for dental services is often below overhead costs to provide those services. Dental clinics which accept discount dental plans are often operating under a bait-and-switch business model. Unless they can upsell patients additional services, which aren’t covered by the discount dental plan, customers will be shown the door. Thus, ethical dental operations want no part of this," says Davis. While these plans are riskier than insurance, a dental discount plan may make sense for you in some cases. Fulop-Goodling shares an example: "If your teeth are in good shape and you need an occasional check-up, and cleaning, a dental discount plan can save you a lot of money." If you're on a tight budget and opt for a dental discount plan, watch out for upselling from your dentist and be prepared to navigate your care without an insurer's or government commission's oversight. You may also want to reach out to your dentist to see what they charge for cleanings. It may be cheaper for you to pay the dentist directly than working with an insurer or dental discount plan.
This is part two of a two part series. Read part one: Dental Insurance with No Waiting Period: What You Need to Know. You're looking for dental insurance with no waiting period because you need a dental procedure now or you want to be sure you have coverage for the care you need as you start making premium payments. Remember that premiums will be higher on these plans than plans with waiting periods — you're paying extra to have immediate coverage. Even with the surcharge for immediate coverage, your plan may exclude coverage for pre-existing conditions. However, if you've had dental insurance before, check to see if waiting periods on other plans can be waived for you. You may be able to save money on premiums and not deal with waiting periods. Below you'll find a summary of what no waiting period policies top-ranked dental insurance companies offer: UnitedHealthcare MetLife Cigna Delta Dental Humana Note: The Ranking, Overall Score, and User Star Rating for the following companies is from April 28, 2020. 1. UnitedHealthcare UnitedHealthcare has earned the number one rank on Best Company among dental insurance companies. Its overall score is 7.1/10, and it has earned a 4.1/5 star rating from reviewers. View the most recent stats and customer reviews. Customer Review: Natalie Brown from Boulder, Colorado "United is great and I highly recommend it! The customer service is very good and the policies they have fit perfectly with my budget. They are affordable but provide good coverage for the year." UnitedHealthcare offers a number of dental plans across the United States. Plan availability may vary by zip code. Some of UnitedHealthcare's plans have waiting periods for basic and major services. Fortunately, it also carries plans that have no waiting periods. However, these plans do not cover pre-existing conditions. UnitedHealthcare categorizes simple fillings and extractions as basic services and crowns, root canals, oral surgery, and bridges as major services. The following plans offer immediate coverage for basic services: Primary, Primary Plus, Primary Preferred, Primary Preferred Plus, and Premier Elite plans. Coverage levels for basic services increase after you've had the plan for one year and again after two years. The Primary and Primary Plus plans do not offer coverage for major services. Primary Preferred, Primary Preferred Plus, and Premier Elite plans have six month waiting periods for major services. Coverage levels for major services also increase after the first and second year on these plans. If you live in Pennsylvania, UnitedHealthcare's Essential and Essential Preferred plans offer immediate coverage for basic services. The Essential Preferred plan also covers major services after a six month waiting period. UnitedHealthcare offers two plans with no waiting periods for both basic and major services: Premier Choice and Premier Plus. Coverage levels for basic and major services increase after you've had the plan for one year and again when you've had it for two years. Learn more about pricing and availability. Back to List 2. MetLife MetLife takes close second place on Best Company with scores tied with UnitedHealthcare 7.1/10 overall score and a 4.4/5 star rating from reviewers. View the most recent stats and customer reviews. Customer Review: CB from Thibodaux, Louisiana "Great coverage! Very trustable when I need something done to my teeth and by far the friendliest customer service to deal with!" While MetLife specializes in employer-sponsored insurance, it does offer two plans without waiting periods for basic and major services: Federal Dental and Veterans Affairs Dental Insurance Program. The brochures for these plans do not explicitly mention not covering services for pre-existing conditions except in a few cases with the Veterans Affairs Dental Insurance Program, like fitting dentures for the first time if the tooth was missing before coverage started, unless it was missing due to genetics. MetLife's Federal Dental plan is for current and retired federal employees. It's also available to retired military members. It has two options: the Standard Option and the High Option. Both options offer in- and out-of-network coverage. The High Option has higher coverage levels for out-of-pocket expenses. MetLife's Veterans Affairs Dental Insurance Program is for veterans. Like the Federal Dental Plan, it has a Standard Option and a High Option. Both plans cover in- and out-of-network coverage. The High Option offers higher cost-sharing and covers orthodontics. Back to List 3. Cigna Third place goes to Cigna, with a 6.9/10 overall score and a 3.9/5 user star rating. View the most recent stats and customer reviews. Customer Review: Katie Carver from Cheyenne, Wyoming "We have had Cigna insurance for a few years and we have been very happy with it. They have always covered what we needed them to cover. No complaints." While a reliable insurer, it's not a great option if you want insurance with no waiting periods. If you've had comparable dental insurance coverage for 12 consecutive months, you might be able to have the waiting periods waived. If you live in Rhode Island, the Cigna Dental 1000 and Cigna Dental 1500 do not have waiting periods. If you haven't had consistent dental insurance or don't live in Rhode Island, you'll want to look at other companies. Back to List 4. Delta Dental Delta Dental has received the most customer reviews compared to the other dental insurers on Best Company. The sheer number of reviews indicates how commonly used the insurer is. It has earned a 5.7/10 overall score and a 4.1/5 user star rating. Such a high user rating from over 100 reviews speaks to the quality Delta Dental offers. View most recent stats and customer reviews. Customer Review: Dwhoush from Pensacola, Florida "I love Delta Dental. The customer Service line is always easy to reach and they answer every question I’ve had." Delta Dental offers plans throughout the United States, and there may be some location-based differences. If no waiting period dental insurance is available in one area, it may be available in others, too. In Arizona, for example, Delta Dental offers two plans with no waiting periods for basic and major services: Turquoise Plan and Copper Plan. Both plans increase Delta Dental's cost-sharing of out-of-pocket expenses after the first and second years of maintaining the policy. The list of exclusions for both plans does not specifically mention pre-existing conditions. While this is hopeful news for anyone needing dental care now, you should ask to be sure before enrolling in a policy. Back to List 5. Humana Humana has earned the number five slot on Best Company with an overall score of 5.4 and a user rating of 3.9/5 stars. View the most recent stats and customer reviews. Customer Review: Brayden Ibert from Houston, Texas "Humana dental insurance is accepted at many places near me and pays a decent amount towards the cost of routine and non-routine dental care. Their website and customer service numbers are easy to use and helpful." Humana offers two plans with no waiting periods: Dental Loyalty Plus and Dental Value. The Dental Loyalty Plus plan has a one-time deductible, which means that once the deductible is met, you do not have to pay any more for your dental care until the annual maximum benefit is met for the year as long as you keep the plan. This plan also has increasing insurer cost-sharing payments and an annual maximum benefit for the second and third year you maintain the plan. The Dental Value plan is a hybrid of dental insurance and a dental savings plan. There is no deductible for these plans. The insurer pays a set percentage for preventive services. There are set fees for basic and major care. This plan puts more financial responsibility on you for the treatment you receive. If you're in Tennessee, Humana's Complete Dental plan does not have waiting periods. This plan has lower, one-time deductibles than the Dental Loyalty Plus plan. It also offers stable cost-sharing levels, which means you may find higher cost-sharing levels earlier than with the Dental Loyalty Plus plan. If a no waiting period dental insurance plan isn't a great fit for you, Humana also offers a dental discount plan: Dental Savings Plus. This plan lets you have discounted fees for dental services you receive. Humana is not clear on whether its plans offer out-of-network coverage, so you'll want to check before enrolling.
You have a toothache and are worried about what the potential costs of treatment might be. Or, you're going to need an extraction and an implant and that care is beyond your budget. Whatever the reason, you need dental care ASAP and don't have insurance to help control costs. You need coverage now. Many dental insurance plans have waiting periods for non-preventive care. Luckily, there are some plans that do not have waiting periods for these restorative services. As you review no waiting period dental plans, read the plan information to understand what the waiting periods look like and what coverage exclusions are part of the plan. You can read part two of this series for more information on what top dental insurers offer or continue reading this piece for expert insight on choosing a no waiting period dental plan. Key Takeaway: Confidently choose a no waiting period dental plan by making these considerations. Evaluate the policy like you would any other dental plan Understand the pros and cons of no waiting periods Explore alternatives Evaluate the plan like you would any other dental plan Dental insurance plans vary widely, so you need to be thorough as you consider plans. You can evaluate plans on your own or with the help of an insurance agent. To ensure that you find a a good fit, check each dental plan's network, coverage, cost, maximum benefits, and effective date. Network There are two main network options offered with dental insurance: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). HMO plans only cover in-network dentists. PPO plans cover in- and out-of-network dentists but have better cost-sharing rates for in-network care. If you already have a dentist you like, check to see if they are part of the plan's network. You should be able to check this online. Sometimes there are errors on the insurance company's provider list, so you can also contact your dentist office to see if they participate in the plan's network. If you want to keep your dentist, you can work the other way around: "Call your dentist to find out what insurance plans they are contracted with. Then, call some of those insurances to find out premiums, maximums, and coverage percentages," advises Summer Holloway, DMD, Floss Dental Boutique. Back to "Evaluate the plan like you would any other dental plan." Coverage Be sure you understand what services the dental plan covers. You probably have immediate coverage needs, but don't let those be your sole focus, especially if you plan on keeping the plan in the long term. "When choosing a plan, think about the future. If you know you need root canal treatment now, pay attention to other treatments. Will a tooth extraction be covered at 100 percent or 80 percent? Often simple procedures are covered in full, but implants are only half covered," advises Henry Hackney, DMD, Authority Dental Content Director. You'll also want to go beyond covered services to get into the details looking for any exclusions and limitations. "The plan may exclude certain treatments or services. Some can only be made available in the following months of membership. They may depend on price or complexity or internal classification. Scaling may be available in the first week, but the jaw X-rays may not be available until the third month," says Hackney. Dental insurance companies have waiting periods and exclude pre-existing conditions to help prevent people from only buying coverage when they need care. If there were no limitations, insurance companies would lose a lot of money. You also need to check for lifetime or annual limitations on the dental work you have performed. Some plans only cover a set amount of fillings on the same tooth during a certain time frame. The plan may also only cover one implant per tooth. In most cases, these limitations won't keep you from having the care you need covered. However, it's important information to keep in mind. Back to "Evaluate the plan like you would any other dental plan" Cost It's easy to focus on monthly premiums as the primary cost of dental insurance. After all, it's going to be a monthly bill. However, the cost of dental insurance also includes your out-of-pocket expenses. Insurance plans have set coverage levels for services, and you'll need to be aware of these cost-sharing features to understand your full financial obligations. First, you'll want to look at the cost-sharing arrangement for specific services. Most plans break services into three categories: preventive, basic or restorative, and major. Coverage for preventive services is typically high. These services include cleanings and regular check-ups. Basic and restorative care includes fillings. Major care includes things like root canals, bridges, and implants. Note that some plans classify implants as cosmetic dentistry and do not cover it. (Read more about dental insurance and implants.) Understand what percentage of the cost your plan will cover and whether or not the coverage level changes over time. In some cases, the longer you have the plan, the higher the coverage levels are. "If you want to use it on the day of signing the contract, it may turn out that you will pay 90 percent or even 100 percent of the visit price. Plans are built in a variety of ways, and it's worth checking your contribution in each month of membership," recommends Hackney. You also need to consider the annual deductible. "Before an insurer will pay any expenses, you will have to pay some of them out of your pocket. Deductibles vary between plans, so choose the one that fits your budget," Mike Golpa, G4byGolpa CEO. If both the out-of-pocket expenses and monthly premiums fit into your budget, then you've found a good contender. Back to "Evaluate the plan like you would any other dental plan" Maximum benefits Before you enroll in a plan, you also need to understand what maximum benefits apply to the plan. There are two types of maximum benefits: annual and lifetime. The annual maximum benefit is usually listed as a per person amount. This is the most that your dental insurance company will pay towards claims in one year. "What are the maximum benefits? There can be a yearly or lifetime limit set on the coverage of your dental costs. Unlike the deductible, you want this one to be as high as possible," says Golpa. Some plans also have lifetime maximum benefits for certain services like implants. You need to know these maximum benefit amounts because you'll assume full financial responsibility once these limits are met. If the costs of the plan are higher than the benefit it offers, you may want to investigate other plans and options. It's a pain to run the numbers, but running the numbers will help you know if buying a plan is worth it. Back to "Evaluate the plan like you would any other dental plan" Effective date The last item to check before you enroll in a dental plan is when your coverage will start, especially if you need coverage ASAP. "It is very important to know exactly when the plan will work. Whether it's on the same day, the next day, after seven days or even a few months when you can go to the dentist and use it. If you want to be able to use it right away, inform your agent at the beginning of the conversation," says Hackney. Back to "Evaluate the plan like you would any other dental plan" Back to Table of Contents Understand the pros and cons of no waiting periods Dental insurance with no waiting period has advantages and disadvantages. Consider these as you determine what kind of dental insurance to buy. "Despite the name, it’s very likely that there will be some waiting period. It usually applies to major works, such as bridges, crowns, and dentures. Your freshly bought No Waiting Period insurance will cover upcoming cleanings and fillings, but not a new crown just a week after. Read carefully terms and conditions," warns Golpa. While it's frustrating that some companies categorize their plans as no wait plans, even if it's just preventive care that has no waiting period, looking at the plan's brochure will help you quickly eliminate plans that do have waiting periods for basic and major dental services. Pros You can receive the care you need with the insurer contributing to the cost without waiting six months to a year. "Dental insurance without waiting periods is a huge advantage for patients! Usually if there is a waiting period (which is rare now), it is six months to a year. Without any waiting period you can get procedures completed before things progress and get worse," says Holloway. Immediate cost-sharing is the primary benefit of dental insurance with no waiting period. Cons Two main drawbacks of no waiting period dental insurance are the cost and potential exclusions. Remember that these are tradeoffs you make for having immediate coverage. You'll need to determine if these tradeoffs are worth it. Costs No waiting period dental insurance plans' premiums tend to be higher compared to plans with waiting periods. While this increased prices can make it trickier to fit dental insurance into your budget, remember that you're paying for the convenience of having immediate cost-sharing for the treatment you need. "No waiting period plans generally cost more. Is the increased premium worth the expected outlay for a major procedure in the first three years? Whether or not there are waiting periods, does coverage increase in the second and third year?" Art Young, Art Young Insurance principal. The costs of dental insurance with no waiting period aren't limited to the monthly premium. Max Meinerz, DDS, of The Good Dentist, identifies other costs: network size, coverage levels, and maximum benefit amounts. Network size "Plans with no waiting period may also have less robust coverage networks because the discounts they negotiate with their network dentists are more steep, giving you less choice in your dental provider. That dental provider also has to see more patients per day to accept a lower fee and still pay the bills," he says. Coverage levels "For example, the percentage of a given dental procedure (filling, cleaning, or dental implant) which the insurance company is willing to pay may be lower in a no wait plan than a plan with a six-month waiting period. These insurers can say they cover fillings and cleanings but that might be at 50 and 80 percent instead of 80 and 100 percent respective to an insurance policy with a waiting period," adds Meinerz. Maximum benefit amounts "Lastly, dental insurance companies use a coverage maximum or amount they will not pay above in a given period of time. A no wait plan often has a lower ceiling at which the insurer refuses to pay and the patient shoulders the remainder of the bill," finishes Meinerz. Potential exclusions In addition to these cost and quality trade-offs, you'll also need to check how your no waiting period plan treats pre-existing conditions. These plans can still exclude them. So, if you're looking for coverage for treatment you need now, even a no waiting period plan may not help you with the cost-sharing you need. "Dental insurance without waiting periods may still include limitations regarding the types of procedures they cover. Or they may exempt procedures that are required due to pre-existing conditions," says Chris Lewandowski of Princess Center Dentistry. As you're looking at no waiting period plans, you may still run into waiting periods. Some plans only immediately cover preventive care. Others only immediately cover preventive and basic care. A few immediately cover preventive, basic, and major care. "No waiting dental insurance implies that there is no waiting period to use the insurance benefits after the insurance policy is in place. However, there may be limitations as to what procedures are immediately covered. Although there is a wide range of policy norms, and a lot of fine print to differentiate themselves, typically major dental procedures (the expensive ones) do have a 90-day waiting period and may be subject to a pre-existing conditions clause. Be sure to ask what procedures are subject to these types of limitations," recommends Lewandowski. Considering the pros and cons of dental insurance with no waiting period, I researched what Best Company's top-ranked dental insurers offer. Read my evaluation of the offerings to learn more about what types of no waiting period policies are available and see which plans may be a good fit for you. Back to Table of Contents Explore alternatives If a dental insurance plan with no waiting periods is a good fit for you, then feel confident about your choice. However, if the premiums are beyond your budget or you want to make sure you've looked at every option, I'll review some alternatives with you: Waiting period waiver Dental discount plans In-house discounts and payment plans Preventive care Waiting period waiver If you previously had dental insurance and no longer have coverage due to job loss, for example, you can look at dental plans with waiting periods and check to see whether the insurer would waive the waiting periods because you've had comparable coverage previously. When you're talking to the insurance company, ask about what the waiver process is, when it occurs, and how quickly you'll be approved or denied. If the approval process only happens after you enroll, you should be careful about proceeding with enrollment and check plan cancellation and refund policies in case waiting periods aren't waived. Back to "Explore alternatives" Dental discount plans A second option is to look at dental discount plans. Dental discount plans are also referred to as dental savings plans. These plans are not insurance. Instead, they offer set rates for dental care received by participating dentists. These plans are nice because the subscription fees are usually cheaper than insurance premiums, the pricing for services is transparent, and there are no waiting periods. While these plans have many advantages, they also have some disadvantages. Lewandowski identifies a few: "Dental savings plans, often called discount plans, can be a viable and financially sound option if the procedures that you require are covered on the plan. Often, only a short list of basic dental procedures are covered on the plan, leaving the majority of procedures uncovered (and billed at the dentist normal price). So not all plans are the same. It may be best to first visit a dentist to find out what treatment is needed, then to shop online for the best saving plan that covers those procedures. Unfortunately, after you find the dental savings plan you want, you may have difficulty finding a dentist you like that takes the plan. After all, the better the discount is for you, the worse it is for the treating dentist!" report_problem Attention: Dental discount plans are not dental insurance. Depending on your state, discount plans may not have regulatory oversight like insurance does. Dental discount plans are also not available in all states due to restrictions. Read "Dental Insurance vs. Dental Discount Plans" to learn more. Back to "Explore alternatives" In-house discounts and payment plans A third option is talking to your dentist about office discounts and payment plans. "Always ask your dentist if they have an ‘in-house plan’ for their patients without insurance. Some offices have great programs that will provide patients with discounts for services. Some offices also offer cash discounts as well," says Holloway. Even if your dentist doesn't offer a discount plan, you may be able to work out a payment plan that can make receiving the care you need easier to fit into your budget. Take advantage of these payment plans and pay more than the regular minimum when you can to pay off your debt faster. Before opting for these plans, make sure that you have a dentist you trust. Like dental discount plans, in-house discount programs do not have regulatory oversight. It's important to find a dentist that puts patient care first. Back to "Explore alternatives" Preventive care Another option is to be proactive with your dental care. It may be too late now, but it can save you money in the future. "In my opinion, the most cost-effective plan is prevention. By staying well hydrated, using topical fluoride, a focus on brushing and flossing and a diet low in acid and sugar, dental disease can be prevented," says Meinerz. If you have a good dentist, their priority is helping you maintain your own dental health. "My goal is to always have the patients not need us. If I take the time to understand your needs and make intelligent recommendations that you follow, most people do not need to spend very much at all on dental services and should be able to stay healthy without dental insurance," adds Meinerz. Regular dental visits allows dentists to catch problems early and take steps to avoid bigger, more expensive treatment. This is why many dental plans offer very good coverage for preventive care, up to covering it fully. Back to "Explore alternatives" Consider your needs — dental and financial — as you evaluate your dental insurance options and weigh the advantages and disadvantages of each. Doing so will help you find a good fit and be prepared to manage the costs of the care you need.
Maybe you need a dental procedure and aren't sure you can pay for it on your own. Maybe you got your first job with benefits and are trying to choose a dental plan. Maybe you're on Medicare and your dental needs are growing. As you start your dental insurance research, you need to understand dental insurance terms, how dental insurance works, and how to evaluate plans. On this list, you'll find helpful articles and resources to help you navigate dental insurance. Understanding dental insurance Dental insurance and dental benefit plans have their own terms. It can be difficult to identify a good plan and know what you're getting without understanding these terms. The resources below will introduce you to these terms and help you understand how dental insurance works. How dental insurance works Understanding Your Dental Insurance Plans and Coverage — Steffany Mohan, DDS Dental Insurance: What’s Covered, What’s Not — WebMD Understanding How Insurance Pays: Types of Coordination of Benefits or COB — eAssist Dental Solutions Types of dental plans Types of Dental Plans — American Dental Association Dental Health Insurance — WebMD Medicare and dental insurance Medicare Dental Coverage — MedicareFAQ Dental Insurance vs. Dental Savings Plans: What’s the Difference? — RetirementLiving Dental Services — Medicare.gov Does Medicare Cover Dental Work? — WebMD Does Medicare Cover Oral Surgery? — Healthline Enrolling in dental insurance Once you can understand dental insurance plans, you'll need to evaluate them to find one that fits your budget and covers your dental needs. The resources below will help you evaluate plans and find reliable dental insurance companies. Tips for deciding whether to buy dental insurance Is Dental Insurance Worth It? — Lifehacker Should You Purchase Dental Insurance? — Verywell Health Is Dental Insurance Worth It? — Millennial Money Man Tips for finding a good dental plan Tips for Choosing the Right Dental Benefits for You — BizJournals Top Dental Insurance Companies — Best Company Tips for seniors A Guide To Medicare Dental Coverage — Aging in Place Best Dental Insurance for Seniors: Expert Tips and Advice — Best Company Best Dental Insurance for Seniors: What Top Companies Offer — Best Company Maintaining oral health Whether or not you have dental insurance, maintaining good oral hygiene will help lower your dental costs and keep you healthy. The resources below will help you develop good habits and maintain your dental health. Ask the Dentist — AsktheDentist.com How Poor Dental Care Can Affect Your Overall Health — Colgate What Can Adults Do to Maintain Good Oral Health? — Centers for Disease Control and Prevention Oral Health: Brush Up on Dental Care Basics — Mayo Clinic Finding affordable care Even if dental insurance and dental care are beyond what you can afford, you may find other options for getting the care you need. Read the articles below to learn more about your options. Where Can I Find Low-cost Dental Care? — U.S. Department of Health and Human Services Free or Low-Cost Dental Care When You’re Uninsured — WebMD How to Pay for Dental Care When You Don't Have Insurance — The Ascent
Since you've got valuable life experience, you know how important it is to work with a trusted company when you're making any purchase, especially with insurance. We'll go over what Best Company's top-ranked dental providers offer seniors to help you understand your options and decide how to proceed. If you want to read expert tips on buying dental insurance, read Part One of this series: Best Dental Insurance for Seniors: Expert Tips and Advice. Best Company uses an algorithm to rank companies. Ranking factors include time in business and other industry markers. The algorithm heavily weights customer reviews left on Best Company — the star rating and quantity. It also considers how companies respond to reviews. All of which is to say: companies cannot buy their Best Company rank. It’s earned primarily through positive customer experiences and reviews. Below is an overview of our top-ranked dental insurance companies and what they offer seniors. As you review your options, you may want to compare rates and coverage across several plans to see which one would be best for you. UnitedHealthcare MetLife Cigna Delta Dental Note: The Ranking, Overall Score, and User Star Rating information included in the following sections are from April 28, 2020. The scores consider reviewers who are seniors and who are not, so the rankings and scores may not fully represent which dental insurer is best for seniors. However, companies that rank high are more likely to treat their plan members well. 1. UnitedHealthcare Overall Score: 7.1/10User Star Rating: 4.1/5 (based on 40 reviews) UnitedHealthcare ranks first for dental insurance. Positive reviewers mentioned good experiences with coverage and customer service. Negative reviewers had issues with plan coverage and costs. Read UnitedHealthcare Dental Insurance Reviews UnitedHealthcare’s plans are through the Golden Rule Insurance Company. It offers dental plans designed for older adults with no age restrictions. While you’ll want to work with UnitedHealthcare directly to learn more about plans available in your area, we looked at Glendale, Arizona as an example. There UnitedHealthcare offers four Dental Gen Plans: Gen Saver Gen Plus Gen Basic Gen Deluxe These are available to seniors age 64 and older. All plans include the following features: No waiting periods EPIC Hearing Healthcare hearing coverage Ability to add vision coverage The hearing coverage includes fixed benefit amounts for an annual hearing exam and increasing coverage for hearing aids every year you maintain coverage (up to three years) but don’t use it. These plans also have similar coverage rates for basic and major dental services. The coverage rates also increase the second and third year you keep the policy. The biggest differences among the plans are the premium costs, deductibles, annual maximum benefit amounts, implant coverage, and network flexibility. The Gen Basic and Gen Deluxe plans offer full coverage for in-network preventive care. The Gen Saver and Gen Plus plans cover in-network preventive care at 60 percent for the first year. The coverage rate increases each year you maintain the policy capping at three years. Only the Gen Deluxe plan offers coverage for implants. It also has the highest annual maximum benefit. The Gen Saver plan has the lowest premium, while the Gen Plus plan offers more network flexibility. Rules about how frequently services are covered may vary by state. Be sure to review the plan’s details on how frequently services are covered and understand the exclusions and limitations in the plan’s brochure. Premium rates will also vary, so work with UnitedHealthcare directly to get more specific details on premium costs. You can also work with UnitedHealthcare to learn more about its general dental plans for individuals and families to see if any of those are options. UnitedHealthcare Dental Insurance Learn more about UnitedHealthcare dental insurance by reading customer reviews. Read Reviews Back to List 2. MetLife Overall Score: 7.1/10User Star Rating: 4.4/5 (based on 42 reviews) MetLife ranks second for dental insurance. It has the highest star rating of the four insurers included here. Positive reviewers mentioned cost transparency, good customer service, and good coverage. There were no 1-star reviews. However, less favorable reviews included issues with coverage and network difficulty. Read MetLife Dental Insurance Reviews MetLife is not as clear on whether they have specific plans designed for seniors. However, it does offer a TakeAlong DentalSM plan that individual buyers can purchase on their own and a Veteran Affairs Dental Insurance Program for U.S. military veterans. It also opened its Federal Dental Plan to retired uniformed service members and their families. The TakeAlong DentalSM plans come in three options: High Option Benefit Medium Option Benefit Low Option Benefit These plans offer comprehensive coverage for dental services — preventive, basic, and major. They also offer in- and out-of-network coverage. Out-of-network coverage gives you more flexibility when choosing a dentist while seeing an in-network dentist also gives you access to negotiated rates. The TakeAlong DentalSM plans also offer coverage for implants and implant repairs, though there are frequency restrictions around the coverage. The biggest differences between the plans are child orthodontia coverage, coverage rates, annual maximum benefit, and deductible amounts. Premium rates also vary based on the plan you choose, location, and demographics (e.g. age). MetLife’s Veteran Affairs Dental Insurance Program is designed for active and retired military service members. It offers a Standard Option and a High Option. Both offer in- and out-of-network care. The biggest differences are the coverage rates and annual maximum benefit amounts. The High Option includes child orthodontia coverage, but the Standard Option does not. If you are a U.S. military veteran, it’s worth exploring MetLife’s program further to get specific details and premium quotes. MetLife’s Federal Dental Plan is open to retired uniformed service members and their families. This plan also has a Standard Option and a High Option. Both offer access to large provider networks, excellent pre-negotiated rates for services, and coverage for adult and child orthodontics. There are also no waiting periods or annual deductibles. Back to List 3. Cigna Overall Score: 6.9/10User Star Rating: 3.9/5 (based on 53 reviews) Cigna ranks third for dental insurance, but has the lowest star rating of the insurers included on this list. Positive reviewers mentioned good customer service, easy-to-use online tools, and satisfaction with coverage and the claims process. Negative reviewers mention difficulty with the claims process, difficulty with coverage, and experiences with a low value for a high cost. Read Cigna Dental Insurance Reviews While Cigna has resources on dental care for seniors, it doesn’t list plans geared specifically for seniors. It does offer three dental plan options that anyone purchasing their own dental insurance can buy. Cigna Dental Preventive Cigna Dental 1000 Cigna Dental 1500 The Cigna Dental Preventive plan fully covers in-network preventive care. No other dental services are covered. The Cigna Dental 1000 offers the same coverage as the Cigna Dental Preventive plan and includes coverage for restorative care. The Cigna Dental 1500 has higher coverage for restorative care and includes some coverage for orthodontics. Back to List 4. Delta Dental Overall Score: 5.7/10User Star Rating: 4.1/5 (based on 112 reviews) Delta Dental ranks fourth for dental insurance. It has the second highest star rating of the four insures included in this article. Positive reviewers noted satisfaction with pricing, coverage, claims processes and payment, and customer service. Negative reviewers mentioned difficulty with prior authorization, difficulty getting things resolved in a timely manner, and high costs for the value offered. Read Delta Dental Insurance Reviews Like UnitedHealthcare, Delta Dental’s plans can vary by location. Delta Dental has a page specifically to help retirees find dental plans available in their area. Delta Dental also offers the same plans to individual buyers as it does to employers. Delta Dental also offers plans designed for seniors through the AARP. These plans are only available to AARP members, and there may be some variation by area. For example, in Arizona Delta Dental offers three plans: DeltaCare USA PPO Plan B PPO Plan A DeltaCare USA offers in-network coverage, two cleanings per year, and up to 24 months of orthodontia. This plan doesn’t have a deductible or annual max. Instead, there are fixed copays for the dental treatment you receive. The PPO Plan B and PPO Plan A offer similar coverage. Both offer in- and out-of-network coverage, three cleanings per year, and implant coverage once you maintain the plan for one year. The differences between these plans are the annual deductible and annual maximum benefit amounts. The PPO Plan A offers a lower deductible and higher annual maximum benefit amount. Because of this increased coverage, the PPO Plan A likely also has a higher monthly premium. All of these plans state that they have no exclusions for most pre-existing conditions. While this is a nice advantage of these plans, you should check to see what kinds of pre-existing conditions are not covered under each plan if you have a pre-existing condition you need to take care of. Dental Insurance for Seniors Learn more about dental insurance by looking at the top-rated companies, their offerings, and customer reviews. Learn More
Transitioning to life as a senior can feel like a brave new world. Your insurance options change. You have new streams of income from Social Security and retirement accounts. You may even have more time to spend with friends and family. As you make this transition, it's important to understand the adulting aspects of senior life, including dental insurance. We'll cover expert tips on the following: What to know about Medicare and dental coverage When to buy dental insurance What to look for in dental plans In Part Two, we'll go over what Best Company's top dental insurance providers offer seniors. What to know about Medicare and dental coverage Original Medicare (Part A and Part B) does not cover dentistry. If you have Original Medicare and want dental coverage, you’ll need to purchase a separate policy. Some Medicare Advantage plans offer some dental coverage, but it’s important to understand what services this additional feature offers. “Medicare Advantage plans rarely offer dental services. If they do, the offered services are limited, usually to preventative care only. Preventative care usually comprises two cleanings and office visits each year with x-rays. Moreover, more often that not, the Medicare Advantage plan requires you to go to an in-network dentist. If your dentist is not in the network, the Medicare Advantage plan won't pay,” says John Barnes of My Family Life Insurance. If you’re considering a Medicare Advantage plan, check to make sure that your dentist takes your plan. If you want more than preventive care covered, you may be able to add coverage to your Advantage plan. “Most plans allow policyowners to buy-up and get more comprehensive coverage. These plans might cost around $25 more a month, but will cover basic services like cavities — as well as larger items like crowns, root canals, and extractions. Most will have a limit of $1,000 in benefits for the insured for the year, but they don't usually have waiting periods — which is nice,” says Adam M. Hyers, Hyers and Associates, Inc. insurance agent. It’s getting easier to find Medicare Advantage plans with decent dental benefits. “Many, if not all, competitive plans are offering dental benefits included in their Medicare Advantage plan offerings. Benefits are going to cover annual cleaning, x-rays, oral exams, and other basic services like fillings and extractions. Many plans are moving towards including root canals and crowns into their benefits, but the amount of benefit you receive will cover a portion of these expenses,” says John Norce, MedicarePortal president. However, if you’re still deciding between Original Medicare and Medicare Advantage plans, you’ll want to carefully compare the health coverage and assess your needs. “I do caution my clients not to purchase Advantage plans just for ancillary benefits like dental and vision insurance. Consumers should really pay attention to the health insurance benefits associated with Advantage plans and how they compare to Medicare supplements,” says Hyers. There are situations where you may be better off purchasing a separate dental insurance policy. Fenella Stevens, owner of the SCR Insurance Company, offers a few examples: 1. They need to buydown to qualify for Medi-Cal or Medicaid. 2. They want or need richer dental coverage.3. Their preferred dentist isn’t in-network. Back to Menu When to buy dental insurance Experts fell into two camps when it came to buying dental insurance. Some thought it was worth buying, others did not. Travis Price, Licensed Income Protection Agent, highlights a few possible issues with dental insurance: 1) Deductible — Before the insurance pays a dime, there's usually a deductible of around $100.2) Tiered co-insurance — The co-insurance usually starts out around 60 percent and increases to 90 percent in year three. As an example, let's say it's your first year with a dental policy and they cover 60 percent, you cover 40 percent and the deductible. Your bill is $1,500. You pay $100+$560 in co-insurance. The insurance company picks up $840. You're paying the insurance company $45 a month. You're only getting $300 in benefit if all your costs for the year. 3) Exclusion periods — Finally, depending on the type of procedure, routine, minor, or major surgery there's usually an exclusion period for three to six months, except for cleanings. 4) Most of the lower-cost plans are reimbursement plans. So you pay, then request your money back. If you’re a disciplined budgeter, it can be just as effective to set money aside in advance of receiving treatment you may need. Indemnity plans can give you access to lower rates and allow you to only pay for the dental treatment you receive. “Instead, I suggest that seniors talk to their dentists about a 'cash payment' amount or ask how much the insurance company pays the dentist and find out if they'd accept that,” says Price. Whether or not you purchase dental insurance, you should consider your dental needs. “As seniors age, generally speaking their dental needs increase. I would say they want to make sure major services are covered well, including partial bridges, crowns, and implants,” says Barnes. If you’re buying dental insurance, it can be smart to buy it before you need services like fillings or root canals. “I always recommend a senior purchase dental insurance now and not wait until dental trouble arises. The reason is that seniors will meet any waiting periods now. Sure, they have to pay the monthly premiums, but that more than offsets your out-of-pocket cost of a major service. Far too often, seniors wait until they have pain and need dental insurance. Then, they are surprised to learn that if they bought the policy a year ago, the dental insurance would cover the service,” advises Barnes. Aside from having the coverage you need, some plans have an increasing annual benefit maximum. “There are many robust dental insurance plans that offer high annual benefits, such as $5,000 annually. However, these plans usually start out at $1,000 or $1,200 annual benefit in the first year. The annual benefit increases each year the longer the senior holds onto the plan. If the senior needs a root canal done and has had the plan for awhile, the plan likely will pay a nice benefit to the dentist, minimizing the senior's out-of-pocket costs,” says Barnes. Back to Menu What to look for in dental plans When evaluating dental plans, look at the following: Network Coverage Cost Network If you’ve established care with a dentist and trust them, you should understand how your dentist works with insurance companies and check to see if they’re in-network. Some dentists contract with insurance companies to provide services at discounted rates. If your dentist does this, you’ll want to see which insurers and companies they accept. “When searching for a plan, it helps to start with your dentist and identify the plans and networks they participate in. Network-based plans, whether DMO or PPO, will provide higher benefits for in-network providers,” says Norce. Other dentists do not contract with insurance companies. Instead, they do balance billing. When this happens, dentists have set rates for services. The dentist will bill the insurance company first. The insurance company will pay what it covers, then you’ll be billed for the rest. In these cases, you’ll want to have a plan that offers out-of-network coverage. If your plan only offers network coverage, you’ll be responsible for the full cost when you receive care out-of-network. Finding a good network goes beyond your general dentist. “It's important that the carrier has a robust dental network of professionals you can see, including oral surgeons,” says Barnes. The more complete a dental network is, the easier it will be to find an in-network provider when larger dental needs arise. Coverage In the past, you may have only used dental insurance for preventive care and minor services like fillings. However, your needs will change as you age. “Generally speaking, as seniors age, their dental needs increase. They will want to protect that need now as waiting until they need dental insurance proves costly. The reason it proves costly is that many dental insurances have waiting periods on basic and major services. These waiting periods are usually 6 and 12 months, respectively. Seniors will want to consider plans that cover implants and any pre-existing missing teeth, in addition to preventative care, basic services, and other major services,” says Barnes. Plans with more robust coverage tend to be more expensive. So, think about the kind of care you’ll need. One distinguishing feature of dental insurance is the waiting periods for some services. Waiting periods mean that the plan won’t cover the service until you’ve been on the plan for a set amount of time. Waiting periods are designed to prevent people from only purchasing insurance when they need costly care. If everyone only purchased coverage when they needed an expensive service, insurance companies would go out of business. If you anticipate needing major services in the future, talk with your dentist about their pricing. Then, determine if it makes the most sense to save money on your own for these services or purchase a dental insurance policy. Consider dental plans as you make your choice. Some plans will increase the annual maximum benefit the longer you have the plan, so purchasing one of these early can be beneficial. The annual maximum benefit is the total amount the insurer will pay towards covered services for the year. As you evaluate plans, also pay attention to what services are covered and what services are not. “Nearly all plans don't cover cosmetic needs. Additionally, and many seniors are not aware of this, many insurance plans do not cover the replacement of pre-existing missing teeth. If seniors have any missing teeth they want repaired, it is important they call the carrier and find out if the carrier will cover the repair/replacement of any missing teeth (once the waiting period is met, of course),” says Barnes. Cost Insurance costs include the monthly premium, out-of-pocket expenses, and the annual maximum benefit. “In choosing a dental plan it is important to compare plans based on how they pay out for comprehensive services like crowns or implants. You should enroll in a plan that offers comprehensive coverage, but also has a premium that is affordable for the long haul because many dental plans have an increased level of coverage after having the policy for a year,” says Troy Baccus, Medicare Life Group owner. It’s easy to focus on the monthly premium because it’s a consistent part of your budget. However, it may be worth paying a higher premium that still works for your budget for better cost-sharing and a higher annual maximum benefit. You first need to understand how your plan handles claims. “You want to see if the plan is an insurance plan or reimbursement plan. Insurance will pay a percentage of the claims where reimbursement plan will pay you based on a standard cost of a procedure in your area,” says Norce. If you have a reimbursement plan, you need to know what the standard costs are in your area and what your dentist charges. Once you know these numbers, you can estimate what your out-of-pocket expenses will look like. If your plan is an insurance plan, you’ll want to look at the coverage rates. Most plans fully cover preventive services. Some plans also fully cover diagnostic services. Plans have different cost-sharing strategies for basic and major services. Compare the percentages across plans. If your plan offers in-network and out-of-network coverage, see how the coverage rates change. It’s likely that out-of-network care will cost you more than in-network care. As you consider the premiums and out-of-pocket expenses for your dental plan, you also need to consider the annual maximum benefit. “Your maximum benefit for the year is important to understand. Should you need a root canal or crown, you want the maximum available benefits to offset the cost of these higher procedures,” says Norce. Understanding what to expect from Medicare, when to buy dental insurance, and what to look for in dental plans will help you make the best choice for your personal finances while taking care of your oral health. Continue reading Part Two to learn more about what top-ranked dental insurers offer seniors.
You're having a tooth extracted, and you want to maintain your chewing ability or your smile. While there are lots of treatment options, including dentures and bridges, you're considering implants. As you consider your options, you also need to understand the costs associated with each of your treatment options. Use this guide to understand the following questions: What are dental implants? Does dental insurance cover implants? Which insurers offer coverage for implants? What kind of coverage does Medicare offer for implants? What if my plan doesn’t offer coverage for implants? What are dental implants? Dental implants are fake teeth that are set directly into your mouth. If you have to have teeth removed or have lost teeth, implants are one treatment option to improve your smile and maintain your ability to chew food. You should always consult with a trusted dental care provider to receive specific advice on your treatment. “Dental implants are man-made roots that are placed in the jawbone to help replace missing teeth. While missing teeth have been replaced for centuries, the modern dental implant has been around for about 55 years and is gaining more popularity as the Baby Boomer generation ages and the need to replace the weakened teeth becomes apparent. There is a push for accessible, affordable and permanent solutions,” says implantologist Dr. Jumoke Adedoyin. Implants are a relatively new dental procedure. They are generally considered a better alternative to bridges and dentures because they tend to be more durable, don’t affect your other teeth, and feel more natural. “When you lose a tooth, the surrounding teeth lose their orientation and the teeth become less stable. The adjacent teeth to a missing tooth will eventually begin moving to fill in the space, and the teeth above or below may begin to migrate toward the space. This shifting and misalignment of teeth can cause a cascade of expensive dental complications like temporomandibular joint (TMJ) disorder, tooth grinding, jawbone deterioration, tooth decay, and gum disease. Implants are the only tooth replacement option that actually helps stimulate bone growth and prevent bone loss; they are stronger than your natural teeth, dentures, partials, or bridges. They last longer than these alternatives, and they don’t damage other teeth,” reports Dr. Charles Sutera, DMD, FAGD. Implants tend to be more durable and usually require less maintenance than cheaper alternatives. “Implants are the more permanent solution in the sense that the teeth don’t move around and that the bone does not resorb. Dentures need to be realigned every four to five years because the whole jawbone is shrinking. Also, implants are considered to be the better solution because it preserves your chewing function almost entirely as it should be. With a denture, you have to re-learn how to chew and it can greatly compromise your ability to digest food,” advises Dr. Mark Burhenne, DDS, AsktheDentist.com founder and number one bestselling author of The 8-Hour Sleep Paradox. While implants have proven to be a better treatment than bridges and dentures and insurance companies are starting to offer coverage for implants, not all dental insurance plans cover them. “Unfortunately, most dental insurance policies do not cover dental implants because most companies categorize these as a cosmetic procedure. Patients who have implants will disagree as in most times, it can be a life changing treatment option, affecting not only their self-confidence, but also their mental well-being and their ability to feel socially accepted,” says Adedoyin. Even though insurance companies don’t always cover them, the demand for implants is increasing. This is good news because the increased demand has made implants more accessible. “Because they are becoming the acceptable option in care, they are also readily available, not only at a specialized dentist’s office. They are being placed by general dentists with advanced training and are more and more affordable,” adds Adedoyin. While still a lengthy and expensive process, not having to pay a specialist to perform the procedure can save you some money. As you consult with your dentist on the best way to proceed with your care, keep in mind these cost trade-offs Sutera identifies: “With proper care, dental implants can last a lifetime. This is not the case for dentures, bridges, or partials — driving up the cost of these alternatives over a lifetime,” he says. Implants may have a high upfront cost, but it may be worth it to you in the long-run because you’ll avoid the maintenance costs associated with the alternatives. While implants are a good treatment option, they aren’t always permanent. You should review the pros and cons of implants and alternatives with your dentist as you make a decision. Burhenne identifies some issues that can arise with implants: “Implants can cause forms of gum disease known as peri-implant diseases. It is difficult to remove them, although I have seen some dentists unscrew them with ease. Trauma to the face could mean that the implant pops out or breaks in the bone, which is another reason they can fail. A further reason for failed dental implants is that the load is unevenly distributed. The load of the dental implant must be distributed evenly over multiple implant systems. Patients with reduced immune response (such as with autoimmune disease) or those who practice a very unhealthy lifestyle (smoking, poor nutrition, chronic disease) are more likely to reject the implants over time.” Back to Menu Does dental insurance cover implants? The short answer is: it depends. First, it depends on the coverage you have. “Most dental benefit programs will only reimburse a small portion of the cost of dental implants. Insurance companies will only reimburse if it’s a covered procedure within their contract. Read the fine print!” advises Dr. Larry Evola, lead dentist at Forestream Dental. While implants are a better treatment for missing teeth, there are cheaper treatment alternatives including dentures, partials, and bridges. These are more commonly covered by dental insurance companies. Does your dental plan cover implants? If your dental plan covers implants, you need to ask how much your plan will cover. “The best thing to do if a patient is really trying to rely on dental coverage and needs to know what they will cover in advance is to submit a 'pre-treatment determination.' The insurance company will give an estimate of what they would pay if the services were rendered, but even with a pre-determination they do not guarantee payment or coverage,” says Jamie Whalen-Murphy, office manager for Courtney Hain, DDS. You should also check to see what waiting periods apply to implant coverage. “For insurance companies that provide comprehensive coverage that includes dental implants, there is typically a required waiting period before the dental implant coverage can be active, so in the case of an immediate need, this policy serves very little benefit and only covers the cheapest replacement option to a missing tooth, which unfortunately is not the same as getting dental implants,” says Adedoyin. You should also review your health plan to understand what your plan’s annual maximum benefit is. That’s the most your plan will pay towards your dental care for the year. “Keep in mind that you also have a yearly maximum that is usually met and maxed out with just one implant. An implant is typically done and several steps over the course of many months. You normally will get the implant done in one visit and come back after the bone has integrated after several months to get a crown placed on the top of the implant,” explains Kelly Hancock, RDH, and oral health writer for Toothbrush Life. You and your dentist can use the timing of the implant procedures to your advantage. “One smart tip to go about this would be to get the implant done at the end of one year and the crown done in the beginning of the next year. Having the two expensive procedures done on two separate years will help you maximize your insurance benefits,” suggests Hancock. Unfortunately, there are some exceptions even if your plan covers implants. “Many dental plans have what is called a 'missing tooth clause,' which says that they won't help cover the replacement of a tooth that was lost prior to the start of coverage,” says Whalen-Murphy. While the kind of dental plan you have affects implant coverage, the reason for the implant has the most effect on whether or not insurance will cover it. “The biggest determination on coverage is whether the service is strictly cosmetic in nature or medically needed for a variety of reasons” says Dr. Andrea Santo, DMD of Lakeview Dental of Coral Springs. If an implant is for cosmetic reasons, you’ll probably be on your own. “Some individuals elect to improve their smiles via dental implants, which is very common and a popular route, but one should not expect notable coverage for instances like that. Other times, insurance may cover a portion of the cost of a replacement tooth, but not the cost of the implant or the procedure. It's really best to consult with your dentist and/or ask around for what your options are,” continues Santo. However, if the implant is medically necessary or dentally necessary, you’ll likely have coverage if your insurance plan offers it. “IF your dentist can prove the extraction, bone graft, and eventual implant treatment was necessary, at best, you'll only be reimbursed $1,500 (your maximum) for the treatment. If so, you've left yourself no money for preventive care for the year, so this is when an HSA/FSA is very helpful, since they help fill in the gaps that traditional health insurance leaves behind,” says Burhenne. You may even be able to get health insurance coverage for it. “What many people may not realize is that dental implants and associated procedures may be considered medically necessary and can be covered by medical insurance because they prevent or restore bone loss of the jaw, which is known as disuse atrophy. Dental implants may also be needed as a result of trauma or an accident, which also renders them medically necessary,” says Sutera. Back to Menu Which insurers offer coverage for implants? Many dental insurers offer coverage for implants in at least one of their plans. A few examples include Guardian and Spirit. You can also use dental plan search engines like eHealth to compare dental plan costs and coverage across companies. While some insurance plans cover implants, keep in mind that the coverage may be limited and there may also be a waiting period. Some dental insurance carriers offer coverage for implants without a waiting period. As you consider your needs and your situation, think through the pros and cons of different plan models. “Because of the cost, most dental insurance carriers have a 12-month waiting period on a major service. Other carriers don't have a waiting period, but these carriers may not pay as much towards the cost of the implant if the implant is needed in the first year. After a year, the plan pays more. Then, there are plans that don't have a waiting period on a major service if the insured currently has dental insurance. However, they might have a lifetime dollar limit on dental implants. This is reactionary and costs individuals far more in the long run. So, for seniors and families, my first recommendation is to purchase dental insurance long before you really need it. You may not need dental implants now, but who knows in the future,” warns John Barnes of My Family Life Insurance. Understanding how the cost-shifting of different plan models works will help you choose a plan that best meets your needs. Back to Menu What kind of coverage does Medicare offer for implants? What you can expect from Medicare varies based on which part of Medicare you chose. “Regular Medicare doesn't cover most dental services, but Medicare Advantage plans often do with an 'additional coverage' option (and fee). Whether dental implants are covered will vary by provider, and you should check your plan description,” cautions Whalen-Murphy. It’s always worth checking to see if care you need is covered. However, given how expensive dental implants are, it’s understandable that chances of coverage may be narrow. “A Medicare Advantage plan is highly unlikely to approve coverage for dental implants. Those with Medicare coverage need to consider other options such as a stand-alone dental plan or paying out of pocket. If those options aren't enough, sometimes discount websites like Groupon have deals on dental services,” says Lindsay Engle, Elite Insurance Partners, LLC marketing manager. Back to Menu What if my plan doesn’t offer coverage for implants? If you already need to get an implant and your dental insurance doesn’t cover it, you’ll want to explore other payment options. Paying a couple thousand dollars upfront isn’t feasible for everyone. If you’ve got time on your side, you can plan ahead. Burhenne recommends taking the following steps to prepare: “Make sure to get a bone graft at the time of your extraction or else you risk not having enough bone to support the implant. Reach out to your health insurance company NOW for a full copy of your plan. This will likely be dozens of pages and will include a multitude of exclusions and loopholes you will want to know about. Start saving now. Utilize savings techniques, Bento dental, and HSA or FSA plans to help you afford it.” If not, here are other payment options to consider: Health insurance Payment plans Loans and health care financing Treatment abroad Discounts and grants Health Savings Accounts and Flexible Spending Accounts Health insurance While health insurance won’t usually cover dental implants, there are some exceptions. “Health insurance covers dental implants when they are medically necessary. Reviews and pre-authorizations need to be sent to medical insurance companies which take longer than dental to determine coverage,” reports Roberto Velasco, Uptown Cosmetic & Implant Dentistry. Examples of when an implant would be medically necessary include the following: “Health/Major Medical may reimburse in cases where implants are necessary due to an automobile accident, for example,” says Evola. “Some medical insurance cover dental implants; however, only when used for fixation of maxillofacial prostheses after cancer reconstruction or severe trauma,” adds Adedoyin. Keep in mind that coverage will vary based on your health insurance plan and how the health insurance company determines coverage. Back to "What if my plan doesn't offer coverage for implants?" Payment plans Remember how the implant process takes time? You can use this time to your advantage to break up the cost into more manageable chunks: “Patients only pay for one stage at a time. Each stage is about three to four months apart. Not having to pay the entire cost at once does help a lot of people,” suggests Whalen-Murphy. As you follow the advice of your dentist, you’ll want to plan your care with your budget in mind. “The best way to defray the cost of a dental implant is to plan it, and stage it. The implant placement sometimes takes two or more appointments, and can last between three to eight months. Using this time to your advantage to make payment arrangements for putting a tooth on that implant works well for most people,” advises Daniel Balaze, DMD, FAGD, and host of the Anything But Dentistry podcast. Back to "What if my plan doesn't offer coverage for implants?" Loans and health care financing Of course, you can go into debt for your implants. “Additional options include getting a line of credit or personal loan from your bank or credit union. However, this may involve paying a high interest rate, so financial planning is warranted before going this route albeit you do get that beautiful smile, which gives you a boost of confidence and maybe you can go for that higher paying job,” explains Adedoyin. Dental implants take several months to complete, so don’t count on a quick income boost right after. And, regardless of how your smile looks, it isn’t the only thing that affects a hiring decision. Before you get a loan, evaluate your financial situation: How much debt are you already in? Could you save enough to pay for it at each stage? What do your savings look like? If you’re considering loans, you need to understand what the interest rates look like and figure out how quickly you could pay the loan off. How much more will you pay in interest for the implant? With interest you’ll spend more money on implants than they actually cost. The faster you can pay off the loan, the less interest you’ll pay. In addition to personal loans from your bank or credit union, you could explore health care financing companies. “There are health care financing companies like CareCredit that will allow monthly payments for implants. This is similar to applying for a car loan,” says Evola. Back to "What if my plan doesn't offer coverage for implants?" Treatment abroad There are well-trained dentists all over the world. With the rising health care costs in the United States, it’s becoming common for people to travel to other countries to receive care at lower costs. However, dental tourism is not without risk. “I would never recommend that anyone have any surgery outside of their own country,” warns Balaze. Balaze offers a several reasons for this: “First is the possibility that there are language barriers and cultural barriers. It is of utmost importance to me that our patients understand all of the risks, benefits, and alternatives to the treatment they are about to have. I can't imagine that this is easy in a second language or in a place where customs and etiquette are different. Second is the ease of having follow up care after the procedure. Especially in oral surgery and implant dentistry, the healing process can take months. If you begin to experience things that you're not comfortable with, how are you able to have your doctor evaluate what is going on? What if the complications are serious?” The third reason is that some dentists take advantage of people. “There are wonderful, skilled, talented and passionate dentists anywhere you go in the world. However, when a person tells me that they went to another country to have their dentistry completed in order to save money, I know that the chances of that dentistry being clinically acceptable are extremely low. It's unfortunate, but I think there are a large number of medical and dental tourism doctors taking advantage of people trying their best to improve their health. Counterfeit and fraudulent treatment is not uncommon,” remarks Balaze. This includes misrepresenting the quality of the implant, abutment, and crown installed. Whether or not you travel to get implants, you need to be sure that you trust the dentist placing the implant. “It is important to know that this can happen anywhere. There was an incident where an Ohio woman was having problems after having a crown placed — she had it analyzed and found that there was lead in it! It's very important to have a trusting relationship with your health care team, which is not an easy task when you are from another country,” Balaze concludes. If you decide to travel abroad for treatment, you should review the Centers for Disease Control and Prevention’s (CDC) resources on medical tourism before you go. These will help you prepare, ask questions, identify risks, and understand what differences to anticipate. Back to "What if my plan doesn't offer coverage for implants?" Discounts and grants Some Section 501(c) organizations receive grants through the American Dental Association (ADA) to support their work to increase access to dental care. “There are other ways to pay for implant treatment; such as government grants that are handed out to non-profits, universities, and state agencies to help improve public health. These include the Samuel Harris Grant and the ADA Access to Care,” confirms Dr. Adedoyin. These grants are usually geared for organizations that help increase access to dental care. However, you may be able to find other options with some research. Alternatively, you can ask your dentist about pricing options or find an office that will offer a discount. Santo has a few suggestions on how to work with your dentist: “Patients can look for offices that offer discounted services, or look for options that provide a bundled-package for multiple dental implants. These are becoming more common due to the rising costs of health care, but I would highly encourage you to perform your due diligence in verifying the practice's reputation and results. Additionally, you can ask the dentist for a discounted rate if the services are not covered by insurance. Many practices are open to discounts to help their patients and maintain their relationships. Your dental office may extend a discount for the non-covered services or honor the insurance contracted rate, but it's highly dependent on your specific dental practice and circumstances for seeking the treatment.” Back to "What if my plan doesn't offer coverage for implants?" Health Savings Accounts and Flexible Spending Accounts If you have a health savings account, you can use those funds to pay for your medical expenses. These dollars are tax-free, which is another benefit. “When dental insurance is not available to someone who needs dental implants, they may want to consider other financial spending and lending options to assist with the financial burden. Many working individuals have medical spending accounts through their employer allowing them to use pre-tax dollars for medical and dental procedures. Additionally, some lending companies offer interest-free financing,” says Dr. Robert D’Alfonso, DDS. If you have a flexible spending account, you can plan to set aside pre-tax money throughout the year to pay for your implants. “Also, using your Flexible Spending Account (FSA) to pay for your treatment is another way to fund your dental implants with pre-tax dollars. Once you pay for your dental implants with your FSA card, which is funded by your employer, you typically have 52 weeks to pay back your employer,” notes Dr. Adedoyin. While dental implants are still expensive, paying the costs using tax-free dollars helps save you money overall. Back to "What if my plan doesn't offer coverage for implants?" Back to Menu