Health Insurance Values » HealthLog with Dave Keller

Dental coverage: Cover your teeth!

When times get tough, many Americans let their teeth go. Thirty-six percent of Americans leave dental care and checkups out when finances are tight — the second most common cost-cutting action of the six in 10 Americans who delayed or skipped health care in the past year, according to an April Kaiser Health Tracking Poll.

Maybe it seems that missing dental visits or eliminating dental insurance won’t hurt too much, but preventative dental care curbs the likelihood of bigger, more expensive dental problems down the road. American Dental Association even shows that advanced gum disease, known as periodontitis, is associated with cardiovascular disease, stroke and bacterial pneumonia.

Studies show that people visit the dentist more often they have dental insurance. As you shop around for a plan, ask your agent questions and keep the following in mind:

What benefits are provided?
Does the plan cover preventative care such as routine cleanings and exams, basic procedures such as fillings, and major procedures such as surgical extractions? What procedures fall into which categories? For instance, some carriers consider X-rays as preventative, while others categorize them as basic.

How much will you pay on top of premiums?
How much is the office visit copay? What will you pay for coinsurance? Some dental plans will cover a certain coinsurance percentage in the first year and then 100 percent in subsequent years. This amount may vary based on the type of procedure — preventative, basic and major.

Are there waiting periods?
Some carriers enforce waiting periods on certain procedures. Make sure you know if such restrictions are in place before you buy. For instance, if you need a basic or restorative treatment such as a filling or a major procedure such as a crown, you may pay out of pocket on top of your premium if it is performed before the waiting period expires.

What is the yearly maximum?
Most dental plans put a cap on benefits paid within a given year. Find out the amount and determine whether or not it fits your specific needs.

Can I choose my provider?
Under a preferred provider organization (PPO) program, you choose from a network or list of discounted providers; if you choose a non-network provider a PPO will cover you at a higher rate. Dental HMOs require you to see contracted providers. And dental fee-for-service plans provide set reimbursement for services rendered and allow you to choose your own dentist.

Get a free online quote on a dental plan for individuals or families »