The percentage of Americans covered by dental insurance is rising rapidly, to 77% by the end of 2016 compared to 55% in 2008, according to the National Association of Dental Plans. The numbers got a boost from the Affordable Care Act, which defined dental coverage as an “essential benefit” for children and offered adults access to dental plans through the healthcare.gov database.

Employee coverage offers more options now, too, and many opt for less expensive medical plans “so that they can use some of their dollars to buy other benefits, such as vision and dental plans,” said Aaron Groffman, president of the Ignition Group, which analyzes dental industry trends. 

Dentists are responding by joining insurer networks. Fewer than 50,000 of America's 200,000 dentists were signed on with the top 15 preferred provider networks in March 2009, but by March 2013 that number rose to more than 70,000, according to Groffman’s data. (For an overview of how dental insurance works, see Should You Bite On Dental Insurance?)

Given the high cost of dental work, everyone would prefer to have some coverage. But how do you choose? Let's zero in on two choices to show how you might evaluate plans and make a choice that fits your needs. The plans you have access to may differ in the details. The two compared here are Assurant Prepaid and Delta PPO, both plans that are offered to federal workers and employees.of some states. (You may also want to read How To Choose A Health Care Plan and 4 Important Steps For Choosing Dental Insurance.) 

DHMO or PPO?

As in medical insurance, the first question comes down to the choice between a dental health maintenance organization (DHMO) or a participating provider organization  (PPO).

PPO networks of dentists are typically larger than those of HMOs. PPOs generally have more expensive premiums and often have larger co-pays.  A PPO allows you to see any dentist, in or out of network, although co-pays are considerably larger for out of network dentists. 

Assurant calls the DHMO offering analyzed here a prepaid plan, which means that the dentists are prepaid for the patients they see for routine dental care. There are no forms to fill out, and Assurant provides the dollar amounts for all copays, which can ease budgeting.  Assurant offers DHMOs in 21 states through employers, and in 16 states as part of individual HMO plans.

Delta sells a variety of PPO options and makes them available through a network of dentists under contract to the insurance company to deliver specified services for set fees. Its plans are offered by employers and through groups such as AARP.

Check Out Local Dentists

If you can’t find a dentist you like who takes your plan and can give you prompt appointments, your dental insurance will do you no good.

First, check the plan’s dental directory to find participating dentists at convenient locations. You might call a few of their offices to find out if their hours suit your needs and the office staff is accommodating. One question to ask: How long will I have to wait for my first appointment? If a dentist's office says you have to wait weeks for an appointment, you might want to try another one.

And, of course, you should ask friends and colleagues for their recommendations. Target folks you know who have had extensive dental work. 

Take Care of Basic Needs 

The biggest benefit of dental insurance is that office visits, including periodic oral evaluations, routine cleanings and X-rays are liberally covered. The idea is to make sure you get good preventive care so that your future dental costs will be reduced.

Even routine care does not come cheaply. An appointment for a cleaning, X-rays and an examination costs an average $198, according to consumer experiences reported by costhelper.com. And dentists recommend that the cleaning and examination be done two or three times a year for most patients.

The Assurant Prepaid has no annual deductible and no charge for X-rays, routine cleaning and periodic oral evaluations by a dentist. There is a co-pay of $10 for an office visit.

Under the Delta PPO, if you use an in-network dentist there is no charge for the office visit, oral evaluation, and routine cleaning, but you’re responsible for 20% of the cost of X-rays.

Both plans charge a copay for amalgam (silver) fillings.

Expect Only Partial Coverage for Emergency Events

Dental plans generally cover only part of the cost of emergency care. Take, for example, the much-dreaded root canal. The Assurant PrePaid has s a $250 co-pay for a root canal by a general dentist and a $600 co-pay for one by a specialist dentist.

The Delta PDO covers 50% of the maximum allowable charge.

Tooth extraction and removal of impacted teeth also have significant co-pays, especially if they are done by a specialist dentist.

Plan for Big Ticket Items

Does someone in the family need braces or dentures? Under Delta PPO, orthodontics are covered at 50% of the maximum allowable charge agreed to by participating dentists. Under Assurant Prepaid, it’s 25% off the “participating orthodontics usual fee.”

Delta might seem to be a better a deal on first glance, but there is a waiting period of 12 months before the benefit kicks in, and the benefit applies only to patients under age 19. 

If you’re an adult or you want the benefit more quickly you might be better off taking Assurant Prepaid. A complete set of dentures will cost you the $310 co-pay plus lab fees at Assurant Pre-Paid, and 50% of the maximum allowable charge at Delta PDO. The estimated cost of dentures varies widely from a median fair price of $1,300, according to Angie's List, to up to $20,000, according to CostHelper. 

Remember the Annual Maximum Benefit

Here’s where Assurant Prepaid might offer the best deal for families with substantial and expensive dental needs. There is no annual maximum on the benefits paid, and pre-existing conditions are covered. Delta PPO has a $1,500 maximum per person per year, and there are some exclusions in the coverage of pre-existing conditions.

And Now to the Premiums

The average annual cost for dental insurance is about $360 a year, as of 2018, according to moneyunder30.com. That varies by state, and by the number of family members covered. The maximum annual benefit usually is between $1,000 and $2,000.

If you get dental insurance through your employer, premiums can be lower if the employer has negotiated a good deal. 

The Bottom Line

If your goal is healthy teeth, having dental benefits and finding a dentist you like can be important. Examine dental plans carefully to make sure you understand the limits of the benefits. It's wise to set aside money for potentially expensive co-payments. If dental insurance is not an option and you need major work, talk to your dentist about arranging a payment plan.

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