While many adults prioritize health insurance, dental insurance for adults is often overlooked. However, maintaining good oral health is crucial for overall well-being.
Here, we will explore why dental insurance matters for adults, things to consider when choosing a plan, and many more.
Overview of Dental Insurance for Adults
The majority of American adults with dental insurance get it through their employer.
The majority of large employers offer dental insurance, and almost all of them pay a portion of the premiums, making it more affordable for employees to sign up for the coverage.
But what if you don’t have access to a dental plan through your employer? There are still options for adult dental coverage; you just need to know where to look.
Various Types of Dental Insurance
Dental plans can either be managed care or indemnity plans.
Plans with indemnity coverage also referred to as fee-for-service plans, do not have provider networks and let you visit any dentist you choose.
However, the plan will only cover a predetermined portion of each service; the remaining balance must be paid by you directly to the dentist. These plans make up a very small portion of the current dental plans and are much less common than they once were.
A PPO (preferred provider organization), HMO (health maintenance organization), EPO (exclusive provider organization), or POS (point of service) plan are all examples of managed care dental plans.
The operation of those kinds of managed care in terms of health insurance is described in the following general terms. For dental plans, the fundamental concepts are the same.
Dental PPOs are the most prevalent type of plan, followed by dental HMOs and dental EPOs, which are both relatively uncommon. There is a network of dentists you can choose from for each of the four types of managed care dental coverage.
Your expenses will be kept as low as possible if you stay in that network (dental HMOs and EPOs typically won’t cover any out-of-network care).
In order for specialty dental care to be covered by some plans, especially HMOs, you may need to have a primary care dentist who will need to write a referral.
Why Dental Insurance Matters for Adults
Dental insurance is an essential part of adult health care, not just for children or in an emergency. This is why:
Preventive care: Having regular dental cleanings and exams can help you avoid developing more serious dental issues. Adults who have dental insurance are more likely to follow a regular oral hygiene regimen.
Early detection: By catching problems like cavities, gum disease, or oral cancer in their early stages, routine dental visits can make treatment easier and less expensive.
Saving money: Dental insurance lowers the cost of dental procedures, which without insurance can be very expensive. This covers everything from simple cleanings to more involved procedures like crowns or root canals.
Improved Quality of Life: Good oral health contributes to better overall health, improved self-esteem, and a raised quality of life.
How Can I Buy Adult Dental Insurance?
If your household income is modest and your state’s Medicaid program includes adult dental coverage, you may discover that Medicaid dental offers all the protection you require.
However, if Medicaid or an employer’s dental plan is not an option for you, you will need to buy your own dental plan on the private market. This is assuming, of course, that you are certain you require dental insurance, which is not always the case.
There are essentially two ways to get your own dental insurance: either through your state’s exchange or marketplace or directly from a business that provides dental insurance for local residents.
Issues to Keep in Mind When Selecting Adult Dental Coverage
When you’re evaluating your options, bear the following in mind:
The ACA does not regulate adult dental insurance. Therefore, the rules that apply to on-exchange pediatric dental coverage will not apply to an adult dental plan, whether you purchase a dental plan directly from an insurer or through the marketplace.
The inclusion of adult dental coverage in medical plans varies from state to state and, generally speaking, from one plan to another within a state. It is possible that some of the medical plans offered in your area will include this coverage.
You should be aware of how the plan handles out-of-pocket expenses, the dental services that are covered, and whether or not dental costs are included in the calculation of the deductible for medical costs.
Your options are impacted by where you live. You might only be able to purchase a dental plan through the exchange if you’re also purchasing a health plan through the exchange, depending on where you live.
In the 33 states that make use of HealthCare.gov, this is the law, though some of the fully state-run exchanges permit people to buy dental insurance on their own.
Federal legislation will become effective that will enable anyone to purchase stand-alone dental insurance through the exchange, regardless of whether they also purchase health insurance.
Enrollment in exchanges is restricted. Only during open enrollment or a special enrollment period are dental plans available for purchase through the exchange.
You can always buy standalone dental plans that are offered outside of the exchange. The only time you can purchase individual or family major medical plans is during open enrollment or a special enrollment period, not during a health insurance enrollment period, regardless of whether you shop inside or outside the exchange.
How Many People Purchase Stand-Alone Dental Through the Exchange?
Every state offers stand-alone dental plans through the exchange, though the number of plan options varies by region.
Nearly 2.3 million individuals nationwide signed up for stand-alone dental plans through the exchanges during the open enrollment period for 2023 coverage.
Only about 209,000 individuals under the age of 18 signed up for stand-alone dental plans through the exchanges, making adults the majority of those who did so.
How are Adult Dental Plan Benefits Limited?
Adult dental coverage purchased separately typically has a benefit cap of $500 to $2,500 per year, with $1,000 to $1,500 being the most typical range.
This should be sufficient for the majority of routine dental procedures. However, if you wind up needing significant dental work, like multiple implants, you might discover that your requirements go beyond the benefit cap.
Preventive services (cleanings, exams, and x-rays) are typically completely covered by any adult dental plan. 70% or 80% coverage is typical for basic services like fillings, extractions, and root canals.
More expensive procedures like crowns, bridges, and implants are frequently paid for equally by the patient and the dental plan, up to the plan’s benefit.
Some adult dental plans will gradually raise the benefit cap or lower the coinsurance percentage.
You might, for instance, choose a plan with a $1,000 benefit cap that increases to $1,250 in the second year and $1,500 in the third.
Alternatively, you might come across a plan that asks you to cover 50% of the price of some services in the first year, 40% in the second, and only 20% in subsequent years.
This kind of plan will reward your loyalty with improved benefits over time if you intend to keep having dental insurance in the long run and you’re satisfied with the dental network it offers.
Does Adult Dental Coverage Have Waiting Periods?
As soon as your plan goes into effect, the majority of adult dental plans will fully cover regular preventive care (exams, cleanings, and x-rays).
However, adult dental plans frequently impose waiting periods of up to a year before covering some of the more pricey dental procedures.
However, if you can provide evidence that you had other dental coverage before enrolling in the new plan, the insurer might waive the waiting period.
Instead of waiting periods, some plans might demand an initial 12-month commitment (with a monthly payment option available).
This would enable you to immediately obtain coverage for important services, but you would be unable to do so once you had received the necessary treatment.
Buying Adult Dental Coverage On-Exchange versus Off-Exchange
Keep in mind that the ACA’s pediatric dental benefits are not required to be provided on plans that you buy outside the exchange if you have children in your family who will be covered by the dental plan with you and you’re shopping outside the exchange.
The overall benefit options, whether purchased on- or off-exchange, will be fairly comparable if you are only purchasing coverage for adults.
The benefits provided to children through an on-exchange dental plan, however, will be significantly more extensive than those provided to adults if your plan also covers children.
Dental insurance can only be acquired through the exchange during open enrollment or a special enrollment period, as was already mentioned.
The exchange might not be a good option if you only need dental insurance because, in the majority of states, it can only be purchased in conjunction with health insurance.
A proposed law for 2023 would permit people who aren’t also purchasing health insurance to purchase standalone dental plans through HealthCare.gov.
For instance, it’s possible that you are employed by a company that offers medical insurance but not dental.
Perhaps you have Medicare and are therefore unable to purchase a plan on the individual market because your original Medicare does not cover dental services and you do not require and are unable to purchase health insurance there.
Fortunately, off-exchange dental plans are offered year-round, nationwide, and without a qualifying event.
It’s important to compare both options because, depending on where you live, different insurers may offer plans both on and off the exchange (assuming you’re qualified to purchase a dental plan through the exchange).
Examples of Stand-Alone Dental Plans Available in the Marketplace
Take the standalone dental plans offered through the exchange (HealthCare.gov) in the Chicago area as an illustration.
For 2023, ten different dental insurers are offering 24 different plans. Although there are three dental EPOs and one dental HMO, dental PPOs predominate.
- The premiums for a single adult are less than $15 per month on the more affordable end of the spectrum, but some of those plans only cover routine preventive care (exams, x-rays, and cleanings).
- Basic and major services, as well as free preventive care, are covered for plans with mid-range premiums ($22 – $26/month for a single adult). Deductibles typically cost much less than $100. Benefit caps range from $1,500 for some of the plans to as low as $800 for others. Most have up to 12-month waiting periods before major services are covered.
- Premiums for the most expensive plans range from $37 to $56 per month. However, these plans continue to have $1,000 or $1,500 benefit caps and waiting periods of six months for fundamental services and twelve months for major services. It is typical to see 70% to 80% coverage for basic services and 40% to 50% coverage for major services, depending on the plan and whether the member uses an in-network dentist.
The coverage specifics of plans in the Chicago area that are offered outside of the exchange tend to be fairly comparable, despite the fact that various insurers are providing plans.
The benefit cap on one plan, provided by UnitedHealthcare/Golden Rule, is $3,000, which is significantly higher than the benefit caps provided by the majority of dental plans.
Is Dental Insurance Worth It?
A single adult’s self-purchased dental plan will typically cost between $10 and $70 per month.
Beware of plans with extremely low premiums because they might only cover preventive care or be dental discount plans. You should always read the entire fine print.
If you choose a plan at the higher end of the price range, you might benefit from higher benefit caps, quicker waiting times, a wider network of dentists, or lower dental care costs.
However, don’t automatically assume that the most expensive plan will provide the best benefits. There are price variations between insurers that are unrelated to the plan’s quality.
Additionally, if you prefer the dentists in a plan with a smaller network to those in a plan with a larger network, you might discover that going with the former will save you money.
Dental insurance premiums for coverage provided by an employer typically have similar costs, but many employers—particularly big employers—pay a portion of the costs.
Adults who purchase their own dental insurance are responsible for all premium payments.
Does Dental Insurance Make Sense for You?
Dental insurance, however, typically makes financial sense for people who require moderately extensive dental work. A crown can cost up to $3,000, and a root canal can cost up to $2,000 on average.
If they have completed any necessary waiting periods prior to the need for care, someone with a dental plan will probably benefit from services like those.
But once more, the benefit caps mean that the coverage offered by the majority of adult dental benefits will be fairly constrained if a person requires extensive dental work.
For instance, because of the benefit cap, multiple dental implants would not be covered in a single year.
Dental Insurance Plan Selection Considerations
You should think about the following when looking for adult dental insurance:
Examine the provider network. Is there a solid rapport between you and a specific dentist? Is it important to you that you can keep going to this dentist?
If so, you should check the networks of the dental plans that are offered to see if your dentist is included. (If there are any plans that the dentist recommends, you can ask them directly.
They may provide a membership in place of insurance that offers you a range of dental benefits so long as you visit their office.
Look for local service providers. You’ll have more options available to you if you’re willing to visit any dentist.
However, it’s still crucial to confirm that the plan has nearby in-network dentists (as well as dental specialists like endodontists and periodontists) who are welcoming new patients.
Analyze the needs of your family. Do you have kids who also require dental insurance? If so, it may be more advantageous to buy a plan through the exchange in order to take advantage of the more comprehensive pediatric dental benefits offered by those plans.
But once more, unless you’re also purchasing a health plan, that might not be an option, and it will only occasionally be offered throughout the year.
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Adult dental insurance is a crucial financial commitment to your general health and well-being. You can manage the costs of necessary dental procedures and maintain good oral health by doing so.
You can make an educated choice to make sure you and your family have healthy smiles for years to come by being aware of the different types of plans that are available, the services covered, and the factors to take into account when choosing a plan.
Don’t wait; begin looking into your dental insurance options right away to give your oral health a top priority.
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