If you are looking for information on dental insurance in Arizona, you have come to the right place. In this blog post, we will discuss the different types of dental insurance policies available in the state, as well as how much they typically cost. We will also provide details on coverage, how to find the best dental insurance policy for your needs, and how to seek treatment regardless of your insurance status.
Dental Insurance Plans
If you’re in need of dental insurance in Arizona, you have lots of options. There are private insurers, Affordable Care Act (ACA) plans, short-term insurance plans, and Medicaid plans.
Arizona dental insurance plans typically cover preventative exams, routine teeth cleaning, fillings, and x-rays. Some plans will also cover periodontics, endodontics, dentures, bridges, root canals, and other surgical procedures.
When choosing an Arizona dental insurance plan, be sure to compare the level of coverage so that you can anticipate the potential out-of-pocket costs. Before selecting a plan, you’ll need to weigh your anticipated needs against plan premiums. For example, if you know you will need more intensive endodontic care in the near future, it might be financially prudent to select a plan with higher coverage, because even with higher premiums you might come out ahead.
Many people in Arizona get dental insurance through their employer’s health insurance plan. However, if that’s not an option, you can purchase dental coverage through stand-alone dental insurance plans on websites such as HealthCare.com and eHealthInsurance.com.
Before purchasing dental insurance, you should compare carriers and coverage levels, and check whether or not your preferred dentist is within the carrier’s network to keep costs at a minimum. You can get a quote online and submit your application to purchase a plan.
PPO
There are two main types of dental insurance plans: PPO and DHMO. A preferred provider organization (PPO) plan will typically give you access to a larger network of dentists than a DHMO. It is also more likely to offer reimbursement for services obtained from an out-of-network dentist.
If you live in a rural area, or a smaller city in Arizona, you might have an easier time finding a dentist that is in-network if you have a dental PPO plan. However, the up-front cost of a PPO insurance plan tends to be a little higher than the cost of a DHMO. That’s because the network is larger. However, if being able to choose a dentist that you’re comfortable with is your priority, you may decide that the higher cost for monthly premiums is worth it.
DHMO
A dental health maintenance organization (DHMO) operates in a similar way to a medical HMO. You will be guided to select a primary care dentist from the DHMO’s network of dentists. This pool of providers is typically smaller than a PPO’s network.
DHMOs are popular because they typically have low costs and no deductible, as long as you see an in-network dentist. However, because they are smaller organizations, it can be difficult to find a dentist that is part of the DHMO’s network. Plus, there’s typically no out-of-network coverage. Thus, if you are outside of the major metro areas in Arizona like Phoenix or Tucson, you may have a tough time finding a contracted provider.
Understanding In-Network Versus Out-of-Network Costs
An important differentiation to understand when comparing your out-of-pocket costs is in-network versus out-of-network. First, out-of-pocket costs are those expenses you pay, regardless of insurance status, that you will not be reimbursed for.
“In-network” health care providers are those that have contracted with your insurance company to accept certain negotiated (discounted) rates. You will typically pay less with an in-network provider due to this agreement. “Out-of-network” providers have not agreed to the discounted rates, thus you will likely pay a higher rate.
Dental insurance plans can vary widely, and this includes what they will and will not include. For this reason, you should read over the terms and conditions of any plan you’re considering to make sure that basic care like fillings and major services like crowns and bridges are included in your coverage. Look for things like out-of-pocket cost minimums and maximums.
For the most part, the majority of dental insurance plans cover preventive care like cleanings and X-rays at 100%. Coverage for basic services like fillings, root canals, and tooth extractions is also usually included, but it’s usually limited to a percentage of the cost, such as 50%. You also can buy coverage that includes major services like crowns, bridges, dental implants, and orthodontics. However, plans that cover major services tend to cost more and often limit the payout to 50%.
To maximize your dental insurance benefits, make sure your preferred provider is on the list of in-network providers.
How Much Does Dental Insurance Cost?
The average dental insurance premium in Arizona is $31.17 per month. However, oral health plans don’t have to be costly. Several dental insurance plans start as low as $8.95/month. These numbers are based on average pricing for 2021 plans from eHealth, but specific prices will depend on your zip code, age, gender, coverage level, and other factors.
Deductible
A dental insurance deductible works the same way that your car or health insurance deductibles work. You are responsible for paying for the costs of dental care up to the cost of the deductible. Once you have met that amount, your insurance will kick in and start covering costs.
The amount of the deductible is usually the maximum out-of-pocket expense that you will have to pay for treatment. This is important information, especially during a dental emergency. Picking a dental insurance plan with a high deductible will help lower your monthly premium costs but likely makes you responsible for paying more out of pocket. If your teeth are in good condition and you’re mostly in need of routine services, choosing a dental insurance plan with a high deductible can be a way to help you keep the cost of monthly premiums low.
Alternatively, if you know you need a lot of expensive dental work done, you may opt to pay more upfront for a plan with a lower deductible, since you’re likely to hit it right away. After that, you will pay a greatly reduced amount for services.
Co-Pays
The amount that you pay out-of-pocket for a dental visit is called a copay. The cost of your copay is based on the type of plan that you have and the coverage that you have. If you have a family dental insurance plan or if you have coinsurance, your deductible might be higher. Co-pay amounts for routine care and emergency care are outlined in your insurance plan.
What If You Don’t Have Dental Insurance in Arizona?
Even if you don’t have dental insurance, you can still seek dental care. Dental care is an important part of staying healthy. Delaying necessary dental care can cause bigger -and more expensive- issues. If you do not plan on purchasing dental insurance, or if you’ve purchased a plan but are subject to a waiting period, you still have options if you need care now.
For example, 19th Avenue Dental Care offers membership plans to help offset dental costs. Additionally, many dentists will work with patients to set up payment plans and pricing tiers to fit the needs of uninsured patients.
Bottom Line
Dental insurance is important for everyone. The cost of dental care in Arizona can be expensive, so it is important to have some type of coverage. Whatever plan you select, make sure to read the fine print. If you’ve recently purchased a dental plan and have questions about your coverage, our experienced office staff at 19th Avenue Dental is happy to assist. Just give us a call today!