How to Choose a Dental Insurance Plan: Types of Plans and Coverage

Open enrollment season puts a lot of decisions in front of you at once. Dental coverage often gets the least attention, yet it shapes how easily you can get care all year. At Blyholder Family Dentistry, we help Wichita families make sense of their benefits every day. Here is what we wish every patient knew before picking a plan.

The Main Types of Dental Plans

The American Dental Association groups dental benefits into a few main types of dental plans. Each one trades flexibility for cost in a different way.

Dental Preferred Provider Organization (Dental PPO)

A PPO pairs traditional insurance with a network of dentists who agree to set fees, according to the ADA’s dental plan overview. You save the most by seeing an in-network dentist, but you can still see an out-of-network dentist and receive some benefit. PPOs are the most common type of dental plan in the country.

Dental Health Maintenance Organization (DHMO)

A DHMO usually has lower premiums and set copays. In exchange, you choose a dentist from a smaller network, and care outside that network is generally not covered.

Indemnity (Traditional) Insurance

An indemnity plan lets you see any dentist. The insurer pays a percentage of the charges for each procedure. These plans offer the most freedom and usually cost more.

Dental Discount or Savings Plans

These are not insurance. You pay a membership fee and receive reduced prices from participating dentists. They can help if you need care right away, since there are usually no waiting periods or annual maximums.

How Dental Coverage is Usually Structured

Most PPO and indemnity plans sort care into three tiers. Many plans follow a patter close to this one:

• Preventive care such as cleanings, exams and digital X-rays is often covered at or near 100%.
• Basic care such as fillings and simple extractions is often covered around 70 to 80%.
• Major care such as crowns, bridges and dentures is often covered around 50%.

A few other terms decide what you actually pay:

• Annual maximum: the most your plan will pay in a benefit year. Once you reach it, you pay the rest.
• Deductible: what you pay before the plan starts sharing costs. Preventive care is often exempt.
• Waiting periods: some plans make you wait months before covering basic or major care.
• Frequency limits: many plans cover cleanings twice a year and certain X-rays less often.
• Missing tooth clause: some plans won’t pay to replace a tooth that was missing before your coverage began.

Coverage for Children and Adults is Different

Under the Affordable Care Act, dental coverage for children is an essential health benefit. Adult dental coverage is not, so health plans don’t have to include it. HealthCare.gov explains how to add dental coverage through the Marketplace, either inside a health plan or as a separate dental plan.

Five Questions to Ask Before You Enroll

1. Is my dentist in network? Blyholder Family Dentistry is in network with Delta Dental and Blue Cross Blue Shield, and we accept several out-of-network plans. Visit our Patient Information page or call us to check yours.
2. Does the annual maximum fit my likely needs? If you expect a crown or implant soon, a higher maximum may be worth a higher premium.
3. Are there waiting periods? This matters most if you already know you need treatment.
4. Does it cover the whole family’s needs? Look at children’s benefits, orthodontic coverage and any lifetime limits on braces or aligners.
5. What will I really pay in a year? Add up premiums and likely out-of-pocket costs, not only the monthly price.

We’re Happy to Help You Decide

Insurance is easier with a team that knows how it works. Call Blyholder Family Dentistry at (316) 684-4921 with your plan details, and we’ll help you understand what to expect before your next visit.