Regular health insurance policies often have a maximum amount in medical costs that you'll pay out-of-pocket. Dental insurance plans often do the opposite: They set an annual maximum on the amount they will pay for treatment in that year.
A typical annual maximum ranges between $750 and $1,500. Frequently, the cost of preventive procedures such as cleanings and X-rays is not subtracted from the maximum.
Obviously, the higher the maximum, the better for you – preferably, at the lowest cost. (To get a sense of prices, see The Average Cost of Dental Insurance in America).
Two Plan Types
Two types of dental coverage do not have an annual maximum – Dental Health Maintenance Organizations (DHMO) and discount dental plans.
Dental Health Maintenance Organization
DHMO plans, also called DMOs or pre-paid plans, require you to choose a primary care dentist or dental facility from the sponsor's network. If you need to see a specialist, your primary care dentist must refer you.
With a DHMO, you pay a fixed dollar amount (also known as a co-pay) for services. In most cases, preventive treatments, such as cleanings and X-rays, have no co-pay; they're included in the plan premiums you pay.
Discount Dental Plan
Discount dental plans are actually not insurance at all, but membership in a group that has negotiated discounted rates with a network of dentists.
There are no maximums or, for that matter, deductibles. You pay for all services rendered plus a (typically small) membership fee to belong to the plan.
Most major dental insurers offer DHMOs and/or discount dental plans. Offerings vary by state, however. So, before you get too excited about a particular option, be sure to see if it is available where you live.
Delta Dental, one of the top-rated dental insurers in the business, has 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-payments. 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 first, before you get into the details.
Cigna’s Dental Preventive Plan may be for you if you want coverage for yearly checkups and not much else. According to Cigna, “Your low monthly premium ensures that Cigna pays for all your annual dental visits.”
The plan has no individual or family deductible and covers 100% of the cost of in-network preventive and diagnostic services. 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. Otherwise, it's only available 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 does require you to 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 in only in areas with a Participating Specialty Dentist (PSD).
Careington offers a popular dental discount plan that the company claims saves members anywhere from 20% to 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 monthly membership ranges from $6.95 for a single member to $15.95 for a 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.
The Bottom Line
If dental insurance is available through your employer, it is almost always preferable to (and less expensive than) buying insurance on the open market, no matter what type of plan it is.
But if that's not an option, if you want to avoid annual maximums, your choices are likely limited to a DHMO plan or a discount dental plan. But 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.
For related reading, see 5 Places to Get the Best Dental Insurance.