The dentist is one place that both children and adults can fear. The combination of needles, painful picks, and loud tools drilling into your mouth, it can cause anyone anxiety. However, the dentist is a very important part of our overall health.
Proper oral hygiene doesn’t just mean we have fresh and clean breathe. A well maintained mouth can improve our memory and lower the risk of heart disease. Brushing and flossing your teeth can save your life.
Dental Insurance 101
Dental insurance is similar to your health insurance policy. You choose a plan, a provider, and pay a monthly premium. Your coverage depends on your plan, which is just like your health insurance is set up. Dental insurance has four types of plans.
- Dental Health Maintenance Organization (DHMO) – Only covers dentists in your network.
- Dental Preferred Provider Organization (DPPO) – Cover in and out of network dentists. In-network dentists are usually lower cost.
- Indemnity Plans – Choose any dentist you want, regardless of network. Pay the bill upfront and then submit reimbursement claim to insurance provider.
- Discount Dental Plans – Unlimited dental care with discounted fee schedule. You still pay a monthly fee and are limited to dentists in your network.
Health insurance is a price we pay to hedge our risk when it comes to catastrophic medical bills. You may never need your health insurance, especially if you’re young and healthy. However, dental insurance is more preventative, at the very least, you’re eligible to go in for bi-annual cleanings.
Therefore, dental insurance has four different classes of services covered. Typically as you progress through the classes of service, the less your insurance will pay and the more comes out of your pocket. A Class I procedure will be fully covered, while a Class III procedure might only have 50% coverage.
- Class I – Diagnostic and preventive care (cleanings, exams, X-rays)
- Class II – Basic care and procedures (fillings, root canals)
- Class III – Major care and procedures (crowns, bridges, dentures)
- Class IV – Orthodontia (braces)
Does Obamacare Require Dental Insurance?
Unlike medical insurance, dental insurance is not required under the Affordable Care Act. It’s not considered essential for anyone over the age of 18. There is no financial penalty to pay.
For anyone under the age of 18, oral health is considered essential. This means dental care must be made available to a child. This can be done through your marketplace medical plan, or through a separate plan.
Why Is Dental Insurance Separate?
There are several stories circulating the internet about why dental insurance isn’t included with health insurance. Some think it has to do with the early history of dentistry, which wasn’t associated as a medical specialty. Others point to the American Dental Association, accusing them of not wanting to be a part of Medicare. But the reason why dental insurance is separate from health insurance might be simpler than that.
Dental insurance is not considered essential, therefore it’s very easy for insurance companies to separate it from health insurance. Since dentistry is primarily preventative care, dental insurance is a lot like a pre-paid plan. There are rarely any situations where you’ll run into exorbitant costs that health insurance protects you from (i.e. heart surgery). It’s relative low cost and non-essential nature are the primary reason why dental insurance is separate.
How Do I Get Dental Insurance?
If you are an adult, there are plans that are offered through the ACA marketplace that include dental insurance. But it’s more likely that you’ll have to obtain dental insurance through an outside provider.
Dental insurance is not a requirement like your health insurance. But it is important to your overall health. Consider obtaining dental insurance to keep your overall health in tact.