How to Choose a Dental Plan

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Although the thought of sitting in a dentist's chair makes some people anxious, the potential cost also drives many away. If you have dental insurance through your employer—or you can afford to purchase it for yourself—it's best to choose a plan that covers the dental care you and your family will need now and in the future.

The cost of dentistry is what keeps more than half of consumers away from the dentist for years at a time, according to a survey by the American Dental Association. Most dental costs are easy to anticipate, though, except for emergencies, such as breaking a tooth. Less obvious dental needs often can be predicted by regular, routine checkups that include diagnostic x-rays to assess the overall condition of the teeth, gums, and jaw.

Other needs to consider are whether you or a family member may require specialty care, such as braces or other orthodontia, dentures or tooth implants or crowns or bridges. These generally are not covered as extensively as routine care, such as exams and fillings.

What's Included in a Dental Plan?

Several types of service are included (to varying degrees) in typical dental plans:

  • Routine and preventive care: These include periodic checkups, cleanings, x-rays and fillings; fluoride and sealant applications to prevent cavities; and certain types of oral surgery, gum care (also called periodontics) and root canals.
  • Emergency care: This includes cracked or broken tooth repair or extraction and treatment following an accident involving the mouth and teeth.
  • Complex care: This includes orthodontia, dentures or bridges. Many dental plans cover about half the cost of these types of procedures.

Kinds of Dental Plans

Freedom-of-choice dental plans offer the highest level of flexibility. This means that any dentist would be covered, and reimbursement does not depend on the type of treatment received.

Many dental plans, however, are managed-care plans that require patients to choose from a pre-approved list of dentists in a network of providers who have agreed to discount their fees. Known as preferred provider organizations, these plans typically allow the dentists and patients to determine what treatment is required and cover a certain percentage of the treatment cost.

PPOs provide more coverage than the next level of care, dental health management organizations (HMOs), which typically cap dentist payments at a fixed amount regardless of the complexity of care needed.

Each level of coverage has a corresponding price tag, with premium payments for freedom-of-choice plans usually higher than those for PPOs or HMOs, respectively.

Dental Plans and Costs 

How much out-of-pocket spending are you comfortable with? A plan's affordability is based on its premium payments (often deducted directly from your paycheck, if your employer offers insurance) and on the cost of dental procedures it doesn't cover.

For example, an HMO may deduct less money from your paycheck, but you will end up footing much more of the end costs of complex treatment, such as bridges, implants or braces. It may not be the bargain you'd hoped for. Conversely, paying high premiums for a freedom-of-choice plan when your dental history is uncomplicated and you only need the dentist to clean your pearly whites twice a year may be overkill.

Before choosing a dental plan, visit your dentist and undergo an exam that includes a set of diagnostic x-rays. Have your dentist assess your overall dental health and determine what, if any, complex procedures are needed by you (or your dependents). This needs assessment should point you in a firm direction as to what level of insurance would best protect you and your wallet. Although it won't make choosing a plan easy, it will simplify your options and needs to determine the optimal match.

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Article Sources
  • Choosing a Dental Benefit Plan. 17 Sep. 2008. Wisconsin Dental Association.
  • Insurance. 2009. American Dental Association.
  • Survey and Economic Research on Dentistry: Frequently Asked Questions. 2009. American Dental Association.
  • Things to Consider Before Choosing a Dental Insurance Plan. 2007. All Insurance