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Summary

Whether you are considering dental insurance on your own, or as part of a benefits package offered by your employer, dental insurance comes in the same type varieties as health insurance: Indemnity (fee-for-service) plans, Managed Care plans, and a PPO type plan. However, the philosophy on which dental insurance was created is somewhat different than health coverage for the rest of your body and so is the coverage. In general, dental insurance covers four areas.

The type of plan determines such matters as:

  • How benefits are accessed.
  • Whether treatments need to be pre-authorized
  • Whether you will have to deal with bills and additional payments 

If you get dental insurance from an employer:

  • A Summary Plan Description will describe the basic features. 
  • If you leave work, you have the right to continue dental coverage under the federal and state laws generally referred to as COBRA. 

Pre-existing health conditions do not affect dental insurance. Neither individual or group dental insurance plans ask about your health condition. On the other hand, there is usually a waiting period when a lot of work is required.

If you can get dental insurance, we recommend that you seriously consider it. Many health conditions will affect teeth or gums at one time or another. Check with your doctor or your disease specific non-profit organization to find out how your condition impacts your teeth and mouth. 

NOTE: If you are considering purchasing dental insurance on an individual basis, check the rates on AARP dental policies. They are often lower than other dental plans. See: www3.deltadentalins.com/aarp/
offsite link

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COBRA

Dental Insurance Benefits

Dental plans cover four general areas. How they are covered depends on the type of policy.

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Dental Insurance Benefits

Using Dental Insurance

Before agreeing to a dental procedure:

  • Check with your dentist to be sure whether he or she accepts your insurance.
  • Check to see how much you will have to pay out of pocket
  • Check to see if the procedure requires pre-authorization from the insurance company. 
  • If you have a tax advantaged health savings account such as a Medical flexible spending account (FSA), check to see whether you can pay the out-of-pocket costs with pre-tax dollars. 
  • If the procedure is major, consider getting a second opinion from another dentist not connected with your dentist. There may be a less extensive (and less expensive) alternative. 
    • Get a copy of your x-rays and test results for the dentist who will provide the second opinion so you don't have to pay for these tests again.
    • Check your insurance to see if it will cover second opinions.  
  • Negotiate with the dentist to see if you can reduce out-of-pocket costs. 
    • If you call other local dentists you may find that other dentists charge less for the needed procedure. If so, this can be the basis for a negotiation.
    • At the least, you may be able to get a discount for paying cash, or if you are a senior. 

If the cost of the procedure exceeds the annual maximum coverage, see if the procedure and thus the cost can be spread out over more than one plan year.
Check your health insurance to see if it will cover a needed dental procedure. For example, Medicare generally pays dental bills if they are related to a medical incident that requires a hospital stay. There may also be basic dental benefits contained in a private health insurance policy. 

NOTE: How claims are filed and whether you need to keep track of payments, depends on the type of dental plan. For more information, see the document in "to Learn More."


 

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Dental Insurance Benefits

If You Have Dental Insurance Through Work And Leave Your Job

Like health insurance, dental coverage from an employer can be extended at your choice under the COBRA statutes.

However, when COBRA ends, there is no guaranteed right to convert dental coverage from group to individual coverage, or to receive a credit for past coverage against a new waiting period if you obtain new dental coverage.

Can I Obtain Dental Insurance Despite My Health Or Dental History?

Whether you are interested in Dental Insurance through an employer, or to purchase it on your own, your health condition is not likely to impact your ability to obtain coverage because there are no questions about your overall health.

Because there is no way to determine the onset of dental problems, there is no attempt to limit coverage for pre-existing dental conditions. This means that if you join a dental plan and need a lot of dental work done, it will usually be covered.

Some plans will impose a one year waiting period on Replacement (Major Services) and Orthodontia procedures. The waiting period is usually waived if you are part of one dental plan and your employer switches to another plan. However, unlike health insurance (see HIPAA), there is no credit for the time you've had the dental coverage against a waiting period from a new employer's coverage. You must go through any new waiting period all over again.