What to Know Before You Select Your New Dental Insurance to Get the Most Benefit

Oct 28, 2024

Choosing the right dental insurance during open enrollment can make a significant difference in how much you spend—and save—on your oral health throughout the year. Whether you need a basic plan to cover cleanings or one with more comprehensive coverage for major treatments, knowing what to look for can help you make the most of your new dental insurance. This guide will walk you through key considerations and questions to ask, so you can feel confident about your choice.

1. Understand the Types of Dental Insurance Plans

When shopping for insurance, it’s important to understand the different types of dental insurance plans available, as they each have pros and cons depending on your needs.

  • HMO (Health Maintenance Organization)
    • Lower monthly premiums but a smaller network of providers.
    • You must choose a dentist within the network, and referrals are required for specialists.
  • PPO (Preferred Provider Organization)
    • Higher premiums, but you’ll have access to a wider selection of dentists.
    • You can visit out-of-network providers, though at a higher cost.
  • Indemnity Plans
    • The most flexible but also the most expensive option.
    • You can visit any dentist, and the plan reimburses a portion of the cost.

Another important aspect to consider is whether your preferred dentist is in-network. Using in-network providers means you’ll pay less out of pocket. 19th Ave. Dental Care accepts a variety of insurance plans, so it’s worth checking if your new insurance includes their services.

2. Evaluate Your Personal Dental Needs and Budget

Your dental needs will play a big role in determining which plan is the best fit for you.

  • What Kind of Coverage Do You Need?
    • If you only need routine care like cleanings and exams, a basic plan may be enough.
    • If you expect to need crowns, root canals, or orthodontics, look for a plan with comprehensive coverage.
    • For families, make sure the plan includes coverage for children’s dental needs, especially if braces are in the future.
  • Review Your Dental History
    • If you’ve needed a lot of dental work in the past, you might benefit from a plan with more coverage.
    • If your dental visits are usually limited to cleanings, a low-cost plan with fewer benefits could suffice.
  • Compare Premiums and Out-of-Pocket Costs
    • While lower premiums may seem appealing, they can sometimes come with high deductibles or limited benefits.
    • Look for a plan that balances affordability with reasonable out-of-pocket costs for treatments you’re likely to need.

Taking time to evaluate your specific dental needs can help you avoid overpaying for coverage you don’t need—or underinsuring yourself for the care you do.

3. Important Questions to Ask Before Choosing a Plan

To make the most of your new dental insurance, here are some essential questions to ask:

  • Does the plan cover preventive services fully?
    • Many plans cover routine exams, cleanings, and x-rays at 100%, but it’s worth confirming.
  • What is the annual maximum benefit?
    • This is the maximum amount the insurance will pay toward your care each year. If you anticipate needing major work, a higher limit may be better.
  • Are there waiting periods or coverage restrictions?
    • Some plans have waiting periods before they cover major procedures, so it’s essential to understand these limitations upfront.
  • What are the deductibles and copays?
    • Knowing how much you’ll pay out of pocket for common treatments helps avoid surprises.
  • Does the plan cover orthodontics or cosmetic treatments?
    • If you or a family member might need braces or teeth whitening, be sure to ask if these services are included.
  • Is your dentist in-network?
    • Staying with a provider like 19th Ave. Dental Care ensures continuity of care and keeps costs down if they’re in-network with your plan.

4. Options for Dental Insurance If Your Employer Doesn’t Offer It

If dental insurance isn’t part of your employer’s benefits, there are still ways to get coverage.

  • Individual and Family Plans
    • Many private insurance companies, like Delta Dental and Cigna, offer standalone dental insurance that you can purchase directly.
    • The health insurance marketplace also offers dental plans, either bundled with medical coverage or as a separate purchase.
  • Discount Dental Plans
    • These plans aren’t technically insurance but can provide discounted rates for dental services. They may be a good option if you need affordable care but don’t want full insurance.
  • State Assistance Programs
    • Some states offer assistance programs for dental care. While Arizona doesn’t have comprehensive dental coverage under Medicaid for adults, it’s worth exploring other community programs for help.

5. Final Tips for Making the Most of Your Dental Insurance

Once you’ve selected your new dental insurance, it’s important to use it wisely. Here are a few tips to maximize your benefits:

  • Schedule preventive care early to avoid the end-of-year rush when appointments fill up quickly.
  • Understand the renewal period so you can plan treatments accordingly—most plans reset annually, meaning unused benefits won’t carry over.
  • Use your benefits before they expire by taking care of any pending treatments or preventive visits.
  • Keep a copy of your insurance card handy and familiarize yourself with any pre-authorization requirements for major procedures.

Choosing the right dental insurance during open enrollment can have a lasting impact on both your oral health and your budget. By evaluating your personal needs, asking the right questions, and understanding your coverage options, you can select a plan that provides the most benefit. If you need assistance or want to confirm that your new plan includes 19th Ave. Dental Care, feel free to contact our office. We’re happy to help you make the most of your coverage and keep your smile healthy all year long.