Maintaining good oral health and preventing dental problems before they happen are important to staying healthy. Dental insurance helps you manage the cost of dental care so you can maintain your overall good health. Most dental insurance covers preventive care, which includes regular checkups by your dentist, and may also cover care for cavities, implants or getting a tooth knocked out.

Dental insurance works a lot like health insurance. Each month you pay a premium (a set dollar amount) and when you visit the dentist, you may be responsible to pay a co-pay, if your plan includes co-pays. The dentist’s office will bill the insurance company directly for your care. Most preventive care visits, which often cover checkups and cleanings, are covered under your dental insurance plan. Your insurance company will pay the dentist directly for your preventive care visits while you are only responsible for your co-pay, if your plan includes co-pays.

If you have a dental procedure that is not considered preventive care, the dentist’s office will send your insurance company a bill and, depending on your plan, your dental provider will bill you for the portion of the procedure your insurance company did not cover. You can find which procedures are covered by reviewing your plan details.

Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group’s plan.

Dental insurance from a preferred provider organization (PPO) means that you can choose any dentist, in- or out-of-network, and you don’t need a referral. You also have the flexibility to visit dentists and specialists outside of your network, but at a higher cost.

With this type of plan, you have the freedom to visit any dentist. The providers of indemnity dental insurance (also known as “carriers”) only make pay for work after they receive and review the dentist’s bill.  Those who subscribe to this type of plan (members or patients) must pay for work in full and then submit a claim to the carrier to be repaid. The payments may be made to the plan member or to the dentist.   Thus, those with indemnity plans pay more out of pocket. On the other hand, compared to managed care plans, they have a broader choice of dentists to work with.

Discount dental plans (DDPs) or “discount dental cards” are not insurance. However, they help consumers save on dental care costs. Members make monthly or annual payments and may receive unlimited dental care services at discount prices based on a fee schedule. Services are provided by dentists who participate in the plan’s dental network.

Dental insurance from a Health Maintenance Organization (HMO) comes at a lower cost, but does not cover all procedures and requires that you only visit dentists and specialists that are in-network. Dental HMO plans also commonly include co-pays.

Today, kids and adults both need braces. If you or a family member needs orthodontic care, or will need it in the future, it’s smart to look for a dental insurance plan with orthodontic benefits in order to manage those costs. Different dental insurance plans offer different discounts on the cost of braces and other devices, so be sure to read carefully through the benefits offered in each plan.

Orthodontic care may not be covered if you begin treatment before you start a dental insurance plan. Be sure to get dental coverage before you start working with an orthodontist.

Some plans will only provide the level of benefit allowed for the least expensive way to treat a dental need, regardless of the decision made by you and your dentist as to the best treatment. Sometimes, special circumstances may be explained to the third-party payer to request an adjustment to this lower benefit allowance, but there is no guarantee that the third-party payer will alter its coverage. As in the case of exclusions, patients should base treatment decisions on their dental needs, not on their dental benefit plan.

Dental plan coverage for individuals is not commonly offered because dental needs are highly predictable. For example, you would not pay premiums for your dental coverage if the premiums were more expensive than the cost of the dental treatment you need. Since this is the case, insurance companies would stand to lose money (spend more on benefits than they receive in premiums) on every individual dental plan they write.