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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 co pays or coinsurance. The insurance company pays the dentist directly for the remainder of the charges not covered by the co pay 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?

Pediatric dental and vision benefits are Essential Health Benefits in Affordable Care Act plans, and if you have children under age 19, you must either include pediatric dental and vision in your Affordable Care Act plan or purchase a "qualified" stand-alone dental and vision care that meets Affordable Care Act requirements for pediatric dental and vision.

Be careful when you are buying an Affordable Care Act plan to determine whether the plan includes pediatric vision and dental. Some carriers have several versions of the same basic plan. One version may include no dental at all; another may include pediatric dental and vision, whereas a third may include both pediatric and adult vision and dental. Moreover, sometimes the plan will not include pediatric dental and vision as an option, so you will need to buy a stand-alone plan.

03. Can Medicare Beneficiaries Buy Dental Plans?

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

There are also carriers that offer plans that are specially designed for Medicare beneficiaries, e.g. dental, vision, and hearing plans offered by several carriers. Please call us at 877-734-3884 if you'd like information about these types of plans.

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 that you pay a certain co-payment for services, or meet a specific deductible before the dental insurance carrier begins payment. Other plans may 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 it cost me on a monthly basis?
  • 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?
  • If I use a dentist outside the plan's network, how much will I have to pay?
  • Are there waiting periods for certain procedures?
  • What services are included?

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.

2020 Schedule
Affordable Care Act Open Enrollment
November 1, 2019 Open Enrollment begins.
December 15, 2019 is the last day to enroll for 2020 on the federal facilitated marketplace.
January 1, 2020 Coverage starts.

2020 Schedule
Medicare Annual Enrollment Period
October 1, 2019 Pre-enrollment period starts. 2020 plans can be discussed.
October 15, 2019 Enrollment starts.
December 7, 2019 is the last day to enroll for a 2020 plan.
January 1, 2020 Coverage starts.

family consulting

We offer a comprehensive set of Affordable Care Act (“Obamacare”) plans

to individuals and families qualified to buy health (tax- and non-tax subsidized) insurance and dental/vision and/or hearing plans through the Federal marketplace (this is called buying “on-exchange” or “on-marketplace”) or directly from insurance carriers (this is referred to as buying “off-exchange or -marketplace”). Our Affordable Care Act policies comply with the Affordable Care Act and contain all of the “essential health benefits” required by that law.

The dental/vision and/or hearing insurance

products are available both on an insured or discount basis

We offer short-term health insurance policies

for those who are looking for more inexpensive coverage and shorter term alternatives.

We offer Medicare Supplement, Medicare Advantage, and Part D Drug plans

to Medicare beneficiaries. Our site is compliant with federal, state, and carrier guidelines in selling these policies. See the Medicare section of this site for details.

We represent many carriers that offer supplemental benefits

to both individuals and families and Medicare beneficiaries, and the site contains information about hospital indemnity, cancer, critical illness, gap, accident, and international medical insurance offered by many different carriers. This section of the site also contains valuable information and tools about lowering the cost of prescription medications. Call us if you want more information about or would like to enroll in one of these products.

We also offer Short- and Long-Term Disability products

and can also help you meet the costs of long-term care, nursing home, or short-term (recovery) care needs.

Finally, we have a complete array of Life, Final Expense, and Annuity products

and offer pre-need services in Florida, as we have both life insurance and pre-need licenses in that state.

You pay nothing for our services:

we’re paid directly from the carriers we represent, Premiums are NEVER EVER marked up to include paying us for our services: you pay the same whether you order directly from the carrier or the marketplace on your own or directly through us or from our site.

We ONLY offer alternatives that are suitable for you and for which we feel meet YOUR needs.
When or if we feel a product or service is not appropriate for you from either a cost or benefit point of view we will tell you so.

We’re fully compliant with privacy and security guidelines, have signed all required privacy and security agreements, have developed a privacy and security policy, and take extraordinary steps to safeguard your protected health and personal information.
In short, we’re experts in all aspects of health and life insurance and also have relationships with professionals who can help you with very specialized situations.

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