While regular health insurance policies often have a maximum amount of medical costs that you're obligated to pay out-of-pocket, dental insurance plans often do the opposite. They set an annual maximum on the amount they pay for treatment for that particular year of coverage.
A typical annual maximum ranges between $750 to $1,500. The cost of preventive procedures such as cleanings and X-rays is generally not subtracted from the maximum. Since dental work can cost an arm and a leg, it's important that you weigh your options carefully. Obviously, the higher the maximum, the better it is for you—preferably, at the lowest cost.
- Dental health maintenance organizations and discount dental plans are two types of dental coverage that don't have annual maximums.
- DHMOs are pre-paid plans for which you pay monthly premiums and receive treatment at no or minimal costs.
- Dental discount plans aren't insurance plans but allow you to get discounted rates at the dentist for an annual fee.
- Both plans require that patients use in-network dentists.
Plans Without an Annual Maximum
There are two types of dental coverage that don't have an annual maximum—the dental health maintenance organization (DHMO) and the discount dental plan.
Dental Health Maintenance Organizations
You must see a dentist that falls in the network of your DHMO plan—also called a DMO or pre-paid plan—if you want to reap the full benefits of your coverage. If you need to see a specialist, your primary care dentist must refer you to one.
Here's how the plan works. Your dentist receives a pre-paid fixed fee from the plan for certain treatment services for every patient they see. In turn, you get the service at either no charge or for a reduced fee. So preventative treatments, such as cleanings and X-rays, have no co-payments as they're included in your plan premiums. If you require more extensive treatments or procedures, the plan will probably charge you a co-pay.
Discount Dental Plans
A discount dental plan is actually not insurance at all. Instead, you get membership in a group that negotiates discounted rates with a network of dentists. There are no maximums or deductibles associated with this type of coverage. Instead, you pay for all services rendered plus a membership fee to belong to the plan. The fee is typically very small and is normally paid annually.
Plan providers give members a card which they present to the dentist's office after getting treated. Using the card gives the member discounts at the office. Since the providers don't reimburse for services, members pay their dentists directly.
Neither dental health maintenance organizations and discount dental plans come with annual maximums.
Most major dental insurers offer DHMOs or discount dental plans. Offerings tend to vary by state. So, before you get too excited about a particular option, be sure to see that it's actually available where you live. Here are some of the notable dental insurers that offer these plans on the open market.
Delta Dental is one of the top-rated dental insurers in the business. The company offers both types of plans—a DHMO plan called DeltaCare USA and a discount dental plan called Delta Dental Patient Direct.
With DeltaCare USA, you select a primary care dentist who manages your dental needs. Like most DHMO plans, DeltaCare USA lets you obtain preventative care for minimal—and in some cases, no—co-pays. This plan has the lowest monthly premium among Delta's offerings. There are no claim papers to fill out—the in-network dentist does all the paperwork.
With the Delta Dental Patient Direct dental discount plan, you choose from a network of participating dentists who have agreed to charge discounted fees. You pay the dentist directly at the time of service. There is no paperwork to file. This plan is not widely available, so it’s important to search Delta before you get into the details.
Cigna’s Dental Preventive Plan may be for you if you simply want coverage for yearly checkups and not much else. The plan has no individual or family deductible and covers 100% of the cost of in-network preventive and diagnostic services—cleanings, dental exams, and routine x-rays. Discounts are available for restorative services and orthodontia.
Cigna’s DHMO plan provides most preventive and diagnostic procedures at low or no cost to you. There are no deductibles, no annual maximums, no waiting periods, and no claim forms to fill out.
Aetna offers standalone dental insurance coverage only in Alaska, Arizona, Delaware, Illinois, and Pennsylvania. If you don't live in any of these states, you may be able to get this coverage through your employer or some sort of group plan.
The company’s discount dental plan, called Vital Savings by Aetna, is widely available and serves as a low-cost substitute for dental insurance, with rates starting as low as $7.99 per month.
The company’s Dental Maintenance Organization plan is available to employees and members of participating organizations. The plan features no deductibles, no waiting period, and no annual maximum. Preventive care is fully covered and discounts (co-pays) are available for other services.
HumanaOne Dental Value Plan (DHMO) has a small one-time enrollment fee, no deductible, and no maximum. The plan requires that you choose a dentist from the network. There is a modest co-pay for routine office visits. Cleanings, checkups, and X-rays are free. Other services are available for discounted prices (including an up to 25% discount for orthodontia), but these are available only in areas with a Participating Specialty Dentist (PSD).
Careington offers a popular dental discount plan that the company claims saves members as much as 60% on most dental procedures. Members may use any participating dentist on the plan. There are no limits on cleanings or major work such as dentures, root canals, or crowns.
Careington's monthly membership ranges from $5.95 for a single member and $11.95 for a member plus their family. A $20.00 non-refundable processing fee is charged when you apply for membership. The plan includes a 20% savings on orthodontics as well as cosmetic dentistry. Careington's site also offers more comprehensive plans as well as an Aetna option.
The Bottom Line
Regardless of the plan, your best bet is to take coverage from your employer rather than try to buy anything on the open market. But if that's not an option and you want to avoid the headache of annual maximums, your choices are likely limited to a DHMO plan or a discount dental plan.
Before you reject the notion of a limit on your benefits, keep in mind that annual maximums are often sufficient to cover the dental care needs of most people—especially if the cost of semi-annual checkups is excluded from them.