Individual Dental Care
The basic coverage for dental care can be purchased as stand alone insurance or as part of a qualified health plan. Most plans are Preferred Provider Organizations with lists of preferred providers.
Basic care plans cover the basic services including regular checkups, cleanings, a certain number of x-rays, and routine prevention care.
HMO providers offer simpler billing procedures but less flexibility for use of out of plan resources. If services beyond basic items are needed, HMO subscribers will have to pay additional fees. There are differences in costs between HMO and PPO providers, deductibles vary with policies, and HMO dental plans often feature low deductibles.
The more expensive and costs intensive forms of care require plans which go beyond basic care such as orthodontics, oral surgery, cosmetic dentistry, prosthesis, and implants.
The Affordable Care Act offers qualified healthcare plans with dental care included, and one can also access stand alone dental health care plans. In the federal marketplace, plans offer dental care as part of a larger set of health care coverage.
In state operated exchanges, such as California and Colorado, consumers can purchase stand alone dental health care plans. Use the FREE search tool above to start your comparison of dental insurance policies!
Low-Income Based Services
Many low income adults are caught in between Medicaid requirement and the amount needed to afford a qualified heath plan with dental benefits. Prior to the Great Recession many states offered dental services to low income adults through Medicaid.
The Affordable Care Act extended Medicaid but many Republican Governors would not permit the benefits to come into their states to help their poor residents. A few states have begun programs to extend dental services for adults that go beyond the minimum of emergency services.
California has begun to revive its program of adult dental care for the poor; the Denti-Cal program was signed into law. However, the availability of dentists and oral care technicians has presented a real barrier to the program’s progress.
While more than half of the state’s dentists have signed up to provide regional coverage, many are not able to take on significant numbers of new patients, particularly those with extensive and complicated requirements.
For forward thinking jurisdictions, providing extensive dental services will save millions over the long course. Poor residents that cannot afford dental care often wind up in emergency rooms for treatment of pain, infections, and worse complications.
The long term costs of serious medical intervention can be avoided with routine and extended dental care. Dental care is not merely cosmetic for appearances, it affects health in fundamental ways and it affects employ-ability in important ways.
Children Services
Under the Affordable Care Act, dental care is an essential health benefit for children 18 and under. Qualified health plans must provide this service and it is part of the premium paid for the health plan. Adults are not treated the same.
Dental care for adults must be purchased as part of a qualified health plan of choice. Adults are free to select a plan which does not offer dental coverage if they wish.
Employer Provided Dental Benefits
Employer based free services are exempt from the requirements of the Affordable Care Act.
Employers provide these benefits without costs to employees as part of employer programs to improve productivity by reducing health related barriers.
Shoppers Must Compare
Comparison shopping for marketplace plans with dental coverage will provide the best results. A free comparison tool can shrink the task of examining choices to a more manageable number.
It is important to focus on the services that fit present and future needs.
Guaranteed and Estimated Dental Premiums
In the health care marketplace, stand alone dental coverage can be labeled in two ways, guaranteed premiums and estimated premiums. Estimated premiums are not contract guaranteed prices, they are only estimates. The provider selected must provide a firm or actual and contracted rate before the first premium falls due.
Guaranteed premiums are set in the plan’s offer. The premium price and terms set on the selection page are the final terms. Guaranteed premiums will often seem significantly more costly than estimated premiums. The insurer can adjust the estimated premium on a number of factors including age, gender, and medical history.
A Need-Based Theory for Dental Care
For many consumers the bane of shopping for health insurance is the occasion when one must buy something one does not and cannot use. For example, some states have a policy of embedding children’s dental coverage in every policy of certain metal tiers.
This practice may have the beneficial effect of ensuring child dental coverage in every plan, but for consumers it has the drawback of paying for something one may not use if one has no children.
The combination of insurance and public policy can cause such results. Not unlike citizens in a community who have no children paying school taxes, yet many people notice pediatric dental and complain.
In 2015 states which had the practice of embedding children’s dental coverage may revise the practice, for example in Colorado many insurers list pediatric dental coverage in every policy but charge no more that $1.50 per month and for some plans the charge is $0.
Health and Dental Tracks
In the United States there is a long standing tradition of separating health insurance and dental insurance. A industry has built up over the years of exclusive dental insurance providers linked to dental healthcare services.
While everyone has a need for preventive services, cleanings, and check-ups, some people have histories of multiple and complicated procedures while others can truthfully say they gave never had a cavity. The market place is geared to those extremes and the insurance offerings to finance dental care are stilted towards the heavy users with complicated and often repeated procedures.
The needs based approach produces a reliable and predictable result which most find satisfactory. Those with few needs can safely decline dental health insurance that requires additional costs. For these persons, routine care is adequate to their needs.
Or those with moderate needs, such as those who require occasional care for common events such as fillings and minor surgical; procedures, an standard dental services add on will suffice.
Heavy users, such as those with complicated histories and foreseeable needs for maintenance and repair of past procedures must shop carefully. They must balance overall caps, and deductible levels to achieve maximum insurance contributions. These users will easily exceed a moderate deductible and then use services to the limit of coverage.
Accessing Dental Coverage
The federal marketplace under the Affordable Care Act does not offer stand alone dental insurance plans. They are available outside of the healthcare exchange in every state. In State run exchanges, residents can purchase stand alone dental policies.
In every state, residents can get quotes on dental insurance fro agents, brokers, and directly
PPO or HMO
There are differences that have cost consequences between the choices of provider’s organization. The Preferred Provider Organization services require use of network providers to get maximum coverage. The consumer usually pays the fees and submits a request for reimbursement.
When selecting outside providers, the reimbursement rate is lower, and for some services, it may be zero. HMO services often perform the paperwork and offer services a preset amounts. Consumers pay a deductible with PPO services and must also watch for service annual caps, which limit the insurers payments.
When comparing the elements of dental plans, consumers can benefit from the use of shopping with a FREE comparison tool, such as the one below. Comparison shopping is needed to identify and compare anticipated consumer needs for dental services.