Between discussions of the Affordable Care Act and the possibility of universal healthcare, medical coverage is on the mind of the nation. A component that tends to hide in the shadows, however, is dental coverage. At times, we may overlook it in the bigger conversation about medical care, but it is an integral part of your overall healthcare.

Determining the right type of dental plan for you and your family can be just as confusing as choosing the right medical plan.

Before we dive into the nuts and bolts of choosing dental coverage, let’s answer a couple of common questions about dental plans.

I Have Medical Insurance; Doesn’t That Include Dental?

Not necessarily. Healthcare benefit packages offered by employers, as well as those you can purchase individually, do not automatically include dental coverage. For adults, dental plans typically are offered separately, if at all. These plans will usually have their own premiums and deductibles and can vary widely in coverage.

Does the Law Mandate Dental Coverage?

Yes and no. It can be a bit confusing, so we’ll try to clear it up here. For children under age 18, dental coverage must be offered when medical coverage is purchased, but you don’t have to accept it for your child. For anyone over the age of 18, dental coverage does not have to be offered.

Dental Insurance is Just Like Medical Insurance, Right?

Again, yes and no. Dental plans do provide coverage for many procedures related to your teeth and dental health. However, they are mostly designed to cover routine preventive care. With medical coverage, the percentage covered often increases as your expenses increase during a calendar year. With dental plans, on the other hand, anything outside of preventive cleanings and X-rays is usually only covered at 50%, if at all.

How Do I Choose?

If you find yourself needing to shop for a traditional dental plan, there are several questions for you to consider.

  1. Do you want to remain with your dentist? If you currently have a dentist that you love and that you want to continue seeing, it is best to ask with which insurance companies they contract. Once you have the list of carriers that contract with your dental provider, you can shop around for the best plan to fit your needs. This way, you can remain under the care of a dentist you trust and with whom you have a relationship.
  2. Are you willing to switch to a new dentist? If you don’t have a dentist or you are willing to try someone new, then you have the freedom to shop for any plan that has a premium to fit your budget, and that will provide the best coverage for you and your family.
  3. Do you or a dependent need any major dental work soon? Often people shop for dental insurance once they know they need a root canal or implants. Unfortunately, that won’t work. Most plans have a waiting period of up to a year before any non-preventive coverage kicks in. Be sure to look at all the plan details and restrictions before signing on the dotted line.
  4. Will you or a dependent need orthodontia? Look carefully at any plans you are considering. Not every dental plan includes orthodontic care, and most cap the amount they will pay at around $1000-$1500. Some policies only cover braces if they are medically necessary, as opposed to cosmetic, so be sure to talk with your orthodontist to know if your care is cosmetic or medically necessary.

dental coverage

Are There Other Options Besides Traditional Coverage?

With rising healthcare costs and a generation of workers who’ve grown accustomed to job-hopping, many people are thinking outside the box when it comes to dental care. If traditional coverage is out of reach financially or is not a good fit for your needs, consider one of the following options:

  • FSA or HSA: Funds deposited in either of these spending accounts can be used for qualified medical expenses, including dental care, as outlined in the IRS code. A flexible spending account (FSA) is owned by your employer and may or may not allow some unused funds to roll over into the next calendar year. A health savings account (HSA) is owned by you, so remaining funds roll over into a new year. HSAs are only available when you have a qualifying high-deductible medical insurance policy.
  • Dental savings plans: Also called dental discount plans, these options operate on a membership basis. You pay an annual fee to be a member, and then you receive discounts on dental services. There are no premiums, no claims to file, and no restrictions against pre-existing conditions. Several insurance companies offer dental discount plans, such as Cigna and Aetna.
  • Payment plans with your dentist: If you do not have any dental coverage, it is worth asking your provider if they will set up a payment plan for you. Most dental offices will work with you to set up payment options, so you don’t have to pay the full amount all at once.

Don’t Ignore Your Dental Health

Regardless of which route you want to take to dental health, there are clearly many options available. From traditional insurance coverage to payment plans, you have a lot of flexibility in your dental care arrangements, and it is worth the time to investigate all of your choices before making a decision.

Medical and dental experts agree that consistent dental care is vital to your overall health and shouldn’t be neglected. Untreated dental problems can lead to further health woes such as infections and even heart problems.

At Tomlin Health Insurance, we look forward to helping you determine which choice is best for you and your family. Give us a call today, and our expert team will be sure to get you on your way to good medical and dental coverage.