What Type of Dental Insurance Do I Need?

Dental Insurance is one of the most important ancillary insurance products that an individual can have to keep their teeth in great shape. Most people have dental insurance through their employer during their working years and are then shocked when they find out Dental is not covered under Original Medicare. Most wonder how they are going to afford cleanings and other dental procedures without any dental coverage. This article will explain dental insurance in detail, as well as give you options for dental insurance in your senior years.


What Are the Different Types of Dental Insurance?


Dental Insurance is rather limited in scope. You only have two options: Comprehensive Dental or Dental Discount.


What is Comprehensive Dental Insurance?


Comprehensive Dental is the kind of insurance you most likely had during your working years. It follows a 100/80/50 payment structure. This means that:

  • 100% of your cleanings and checkups are covered

  • 80% of minor work such as cavities are covered

  • 50% of major work such as Root canals, Bridges, Crowns, Dentures etc. are covered

With comprehensive dental you pay a monthly premium, and receive routine cleanings and checkups covered at 100%. You will then share the costs of your more expensive procedures with your insurance company. Note that most insurance companies have a maximum dollar amount that they will offer towards procedures per year. This amount is usually $1000-$1500. This means if you have a year with multiple high-cost dental surgeries, you can be stuck paying a large amount of the bills yourself.


What is a Dental Discount Plan?


Dental Discount Plans are an alternative to comprehensive dental. The monthly or annual premiums are much lower than those of comprehensive dental, and the payment structure is a bit different. Instead of having set payout structures like Comprehensive Dental does, Dental Discount offers up to a certain percentage off each individual dental procedure. You will pay out-of-pocket for cleanings and x-rays, as well as for more major and minor work such as cavities and root canals. These are often offered through carriers like Cigna and Aetna.


Dental Discounts can also be offered directly through your dentist’s office. These plans typically cost less than comprehensive dental and may even include free cleaning twice a year. Unlike a traditional dental discount, the percentage off each individual procedure is slightly less.


The major difference with any Dental Discount is there is no maximum coverage amount like there is with Comprehensive Dental. You can get multiple expensive procedures done throughout the course of a year and they will still share costs with you.


How Do I Choose Between Comprehensive Dental and Dental Discount?


This choice is straightforward. If you have healthy teeth and are looking to maintain this health, comprehensive dental is the choice for you. It will allow you to get everything you need covered at a reasonable monthly premium and give you peace of mind in case something more serious were to come up.


If you have several costly dental procedures coming up soon, it is worthwhile considering a Dental Discount Plan. Dental Discount Plans don’t have a cap on the services they cover, leading them to often be the better option for those who will have high dental bills. Comprehensive Dental does have a maximum payout each year, which could leave you footing the bill for major dental surgery.


In a situation where you have expensive dental procedures coming up, know that it will be expensive regardless. Both options will leave you paying sizable out-of-pocket costs, and you should be ready for several hundred- or several thousand-dollars' worth of bills either way. The right choice can save you serious money, so be sure to compare the two options’ costs for the procedures you need.


How Does Dental Insurance Work with Medicare?


As we said earlier, Dental is currently not covered under Original Medicare. It is not part of any Supplemental or Prescription Plan either. You will have to get a separate Comprehensive Dental or Dental Discount Plan on top of your Original Medicare coverage.


What About Dental with Medicare Advantage Plans?


Most Medicare Advantage Plans do have a comprehensive dental benefit. This means they will cover things like cleanings and check-ups for free, but you will have to pay for major and minor work at a discounted rate out-of-pocket.

Joining a Medicare Advantage Plan is a big move, and we recommend you don’t go with this option solely for dental benefits. You should also research the benefits they are advertising and see if they are readily available.


Can I Keep My Works’ Dental Insurance?


In some cases, you can! When you retire, your company may offer you “retiree benefits.” These benefits work similarly to the work insurance you previously had and will usually include dental. In most cases it makes sense to take Medicare instead of taking your retiree benefits, but you can sometimes choose specific benefits from the plan a la carte. Talk to your HR or benefits department to see if you can keep their dental insurance without taking your full retirement benefits.


When Do I Sign Up for Dental Insurance?


Dental Insurance enrollment is not tied to any hard dates like Medicare is. You can sign up for Dental Insurance at any time. Some plans may require a waiting period of a year before they approve a major dental procedure, so check the benefits carefully. And if they don’t have a waiting period, they will likely make you sign an annual contract for coverage


How Do I Know My Dentist Accepts the Dental Plan I Want?


The only way to be sure your dentist takes a plan you are interested in is to call them directly. Dental insurance will list what dentists are in their network but oftentimes these networks are not up to date. Or your dentist will only cover specific plans from an insurance company, which may or may not include the one you are looking to enroll in. Be sure to call your dentist directly to see what they take. The best dental insurance in the world doesn’t matter if the dentist you want to see doesn’t take it.


Our Thoughts


Dental insurance can seem complicated, but it only comes down to two options: Comprehensive Dental and Dental Discount. Most people will take comprehensive dental, some will get dental through their Medicare Advantage Plan, and others will choose a Dental Discount for major work. We always recommend you make your healthcare decisions based on hospital and medical coverage and then look at your dental options secondary.


Talk to the brokers at NJ Life & Health to make sure you have the best medical and dental coverage you can get. We will go through your options and get you comprehensive healthcare for you and your family during your senior years. Visit our website at https://www.njlifeandhealth.com/request-an-appointment or call our office at 848-226-6897 to schedule your appointment today.

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