Dental FAQ’s

01. What's The Difference Between Dental Insurance And Discount Cards With Dental Discounts?

With dental INSURANCE you pay a monthly premium to an insurance carrier. You pay the dentist directly for any copays or coinsurance. The insurance company pays the dentist directly for the remainder of the charges not covered by the copay or coinsurance. Many of these plans have deductibles. You're responsible for paying the deductible.

Most dental plans have waiting periods for services other than preventive care, but there are insured dental plans listed on the site that have no waiting periods at all or waiting periods for some but not all services. Insured dental plans have yearly maximums on what is payable under the plan.

With a dental DISCOUNT or SAVINGS plan you pay the dentist directly at the time dental services are rendered, generally in accordance with a published schedule. The company offering the discount program does not pay any money to the provider. You pay a monthly or annual fee in exchange for discounted rates at participating dental providers. Discount dental plans have no waiting periods or annual limits. Services can be received ONLY from providers who participate in the program. NOTE: these are discount plans and are NOT insurance.

02. Is Dental Coverage Part Of Affordable Care Act Plans?

Before the tax penalty was eliminated for not having insurance that met Affordable Care Act requirements, pediatric dental and vision for children under age 19 had to be included in all plans. However, that requirement has been eliminated. Pediatric dental and vision is still an essential health benefit, but the present rule is pediatric dental and vision benefits must be included as part of a health plan OR as stand-alone benefits. There is NO requirement to purchase such coverage, at least in Florida.

There is no consistency between carriers or even between plans with the same carrier. In the case of Florida plans, dental coverage is not included in Affordable Care Act plans. HOWEVER, some carriers include pediatric dental (and vision) on some plans, and some carriers include adult dental (and possibly vision). Be very careful when choosing plans if pediatric and/or adult dental (and/or vision) is a requirement for your coverage when you choose plans.

03. Can Medicare Beneficiaries Buy Stand-Alone Dental Plans?

In most cases, stand-alone dental plans available to individuals under age 65 are available to Medicare-eligibles, and there is no age limit for obtaining coverage with almost all carriers. We feature these types of plans on this site.

There are also carriers that offer stand-alone dental, vision, and/or hearing plans that are specially designed for Medicare beneficiaries. Please call us at 561-734-3884 or 877-734-3884 (TTY: 711) if you'd like information about these types of plans.

The NCD and Physicians’ Mutual plans can be particularly attractive for those looking for higher than normal out of pocket maximum benefits. Please call us at 561-734-3884 or 877-734-3884 (TTY: 711) for details.

04. How Does Dental Insurance Work?

Dental insurance works much like health insurance works. For a specific monthly premium, you're entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.

05. What Kinds Of Dental Plans Are Available?

Like health insurance plans, dental insurance plans are usually categorized as either Indemnity or managed-care plans (Dental PPO plans fit in this latter category). Put broadly, the major differences concern choice of dental care providers, out-of-pocket costs and how bills are paid.

Typically, Indemnity plans offer a broader selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).

Managed-care plans typically maintain dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed-care dental plan and a broader choice of dentists with an Indemnity plan.

06. What Is The Best Dental Plan For Me?

Although there is no one "best" dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you'll have to pay monthly for your coverage, what benefits are covered, and how much you'll have to pay when dental services are rendered. Some plans will require you to pay a certain copayment for services or meet a specific deductible before the dental insurance carrier begins payment. Most plans limit coverage to a specific dollar-amount maximum per year.

When reviewing your dental insurance options, here are a few questions to ask yourself:

• How much will the monthly premium be?
• Will I be required to meet a deductible?
• Once the deductible is met, how much will the dental insurance provider pay for my services?
• What dentists participate in the plan's network?
• Are these dentists that my family and I would like to see?
• Can I use a dentist outside the plan's network and, if so, how much will I have to pay?
• Are there waiting periods for certain procedures?
• What services are included? Are certain services excluded or do they have different limits than the maximum out of pocket limit for the plan?

Some dental plans provide coverage only for preventive care and other services are covered at a discount. Other plans cover most dental services.

07. What Is A Dental Indemnity plan?

A Dental Indemnity plan is commonly known as a fee-for-service or traditional plan. If you select an Indemnity plan you'll likely have the freedom to visit any dentist you wish. You typically will not be required to obtain referrals; however, some plans may require you to obtain pre-authorization for certain procedures.

Most Dental Indemnity plans require you to pay a deductible. After you have paid your deductible, Indemnity policies typically pay a percentage of "usual, reasonable and customary" (R&C) fees for covered services. For instance, the insurance carrier may pay 80% and you may be required to cover the remaining 20% of R&C.

08. What Is A Dental PPO?

Dental PPO (Preferred Provider Organization or Participating Provider Organization) plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan, the patient typically obtains care through a network of dental providers who agree to serve the plan's members at reduced rates.

When you use a network provider, you'll typically pay a certain percentage (e.g. 20%) of the reduced rate, and the insurance carrier will pay the remaining percentage (e.g. 80%). As a member of a Dental PPO plan, you may use dentists outside of the Dental PPO plan network, but you will typically only be reimbursed based on the amount that a network dentist would have accepted as payment in full. The rest of the total charges will be considered the patient's responsibility.

09. What Is The Difference Between An In-Network And Out-Of-Network Dentist?

An in-network dentist is one contracted with the dental insurance carrier to provide services to plan members for specific pre-negotiated rates. An out-of-network dentist is not contracted with the insurance carrier.

Typically, if you visit a dentist within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network dentist. Although there are some exceptions, in many cases, the insurance carrier will either pay less or not pay anything for services you receive from non-network dentists. As a general rule, Dental PPO (and other managed care) plans utilize provider networks. Dental Indemnity plans typically do not utilize a network of providers.

10. What Is A Dental HMO?

Some carriers offer Dental HMO (health maintenance organization) plans. These plans usually have a lower premium than Dental PPO or Indemnity plans that pay similar benefits. These plans work in concept much like an HMO plan for health insurance. You must choose a general dentist and, in most cases, you must obtain a referral from the general dentist to see a specialist. There are no out-of-network benefits except perhaps in emergencies.

Some Dental HMO plans pay based on published fee schedules; others have cost sharing (such as the 20% and 80% cost sharing described in question 8 for Dental PPO's). Dental Indemnity and PPO plans are likely the most common types of insured dental plans, BUT you may find Preventive Dental (see question 5) and Dental HMO plans available in your geographic area.