A Guide to Full Coverage Dental Insurance

No matter how hard we try to avoid them, life is full of surprises, and visiting the dentist is no exception.  Sometimes, your teeth, mouth and gums break down despite how well you take care of them.  Age also takes its toll, potentially leading to bridges, crowns and dentures.  Accidents can also cause major damage.  You may lose or damage your teeth if they are knocked out or you bite down on something the wrong way and a tooth crumbles into several pieces.

Many people don’t like going to the dentist because they fear the pain, even though dentistry has advanced to the point where pain has been minimized or eliminated for most procedures.

Perhaps what people now fear the most is the financial pain that comes from paying for everything from routine fillings to expensive restorative work.

What is Full Coverage Dental Insurance?

While not all financial dental pain can be eliminated, when a patient opts to purchase full coverage dental insurance, they can reduce a large amount of the costs associated with their dental work.

There are many options when it comes to full coverage dental insurance.  It’s best to anticipate current and future dental needs and then if it makes sense, purchase an appropriate policy to meet those needs.  Do the kids need braces?  Have you put off getting bridge work done?  Do you need to place a crown on a troublesome tooth?  Nobody can plan for all eventualities, but making an educated guess is a good start when it comes to deciding what insurance is right for you.

If you’re not sure what your future needs will be, sometimes it makes sense to just go with a policy that provides preventative and basic care such as regular visits and cleanings.

After you decide what your needs are, if you have a dentist you already use and like, check with him or her to see what dental insurance their office accepts.  It may be worth it to pay a little more if you’re happy with the service, or you may choose to go to a new provider if budget is your primary concern.

When shopping for dental insurance, you must also decide if you want to pay monthly premiums and co-pays when you visit, or if you would prefer to pay full amounts to the dentist all at one time.

Full service dental plans come with various options and can be tailored to your specific needs.  Preventative services receive the highest amount of coverage, but plans will vary depending on the types of procedures that are covered and to what degree.

Just like any other insurance policy, you pay a premium and receive coverage in exchange.  When you pay a higher premium, you will likely receive better coverage and have lower copays and deductibles.  However, you must shop around to make sure you find just the right mix of services, premiums and coverage for your particular situation.  You should also be aware that dental insurance plans may also provide coverage for using dentists that are out of the plan’s network, but in most cases, the costs to a patient will be more.  It’s always advisable to try and use an in-network dentist whenever possible.

What is Covered by Full Coverage Dental Insurance?

There are three levels of “full coverage” when it comes to dental insurance.  Depending on the level or the procedure, some plans require a patient to go through a waiting period before coverage will kick in.

Class I services include diagnostic and preventative visits such as x-rays and regularly scheduled cleanings.

For preventative services, there is usually no waiting period because dental insurance providers want patients taking a proactive role in their own dental health.  When a person keeps their mouth, teeth and gums clean and disease free, they require less invasive and costly procedures which could result in expensive future claims against an insurance provider.

Class II coverage include basic restorative care such as fillings and root canals.

Class III coverage includes major restorative care such as crowns, bridges and dentures.  This level includes all work that replaces damaged and missing teeth.

When you need to have major work done, you should also check with your medical insurance provider who may be able to cover some of the costs associated with your dental work.  For example, your medical insurance may cover the cost of antibiotics you will need to take before having a root canal done.  Similarly, medical insurance may cover a part of any oral surgery procedure that is required due to non-biting accidents or related diseases.  This can include jaw surgeries for extracting wisdom teeth, skeletal deformities, cleft palate or facial issues associated with sleep apnea or other airway obstructions.

Unfortunately, health insurance rarely pays for dentures, implants or bridges because these treatments only address function, comfort and appearance, so they are not deemed medically necessary.  However, health insurance may cover braces that are necessary to reposition teeth after a non-biting accident.

There are some other things to know when it comes to dental insurance coverage.

If a person has a medical emergency and needs treatment, then health insurance covers emergency dental work.  Traumatic injuries from accidents, playing sports or other similar situations should be covered and claims should be paid to remove, repair and restore natural teeth and any tissues in the mouth.  Filling a cavity or dealing with a toothache does not qualify as a medical emergency.  Reimbursement assumes that the patient already had health insurance in place before the accident or medical emergency took place.

Unless expressly stated or added as a rider, dental insurance will not cover procedures that are considered purely cosmetic.  This means there is no payment for tooth colored fillings, invisible braces or adult cosmetic orthodontics.  If this is a type of treatment you are considering, you should shop around to see what coverages are available and what you will be required to pay.

If you had dental insurance that expired no more than 60 days prior to seeking new coverage, that full coverage dental insurance providers will often waive the pre-existing condition exclusions.  This means if you need major work, the new provider will often pay for services without waiting periods.  Two groups that qualify for this benefit include anyone who recently lost coverage after changing jobs or for other life events (divorce or death) and people with existing plans who are seeking a second and supplemental policy.

Factors That Impact Full Coverage Dental Insurance Costs

Trying to determine how much full coverage dental insurance costs is like trying to figure out how much a car will cost.  You simply can’t put an accurate price tag on how much your coverage will cost without first identifying the factors that will impact what those costs will be.

In general, it’s estimated that Americans pay about $360 per year for dental insurance with costs running between $15 and $50 per month.  Factors that influence what exact premium costs will be are location, the type of dental plan you choose, your overall dental health and what type of provider you choose.

Another factor is how much the maximum annual benefit is for the policy you choose.  Most amounts fall between $1,000 and $2,000, but unlike medical insurance where you must meet a deductible before coverage kicks in, with a maximum amount in place, coverage ends when you reach your annual limit.  You are on the hook for any costs that go over the specified amount.

One of the most common full coverage dental insurance plans that is offered is known as 100/80/50 coverage.  Taking the three levels of dental care into account, this means that preventative care is covered 100%, basic care is covered 80%, and major care is covered 50%.

You can also add orthodontic care for an additional cost if you know that braces are in the future for one or more of your family members.  A few plans will let you also add cosmetic care coverage for teeth whitening, bonding, veneers, or bleaching procedures, but in most cases, this is an out-of-pocket expense.

To fund dental procedures that are required immediately but not covered by insurance, many people turn to financing programs that may include personal loans from a lender, practice payment plans set up directly by the dentist, or using a credit card to pay for services.  Each has pros and cons that should be weighed before making a final decision about how to pay for services.

Low Cost Alternatives to Pay for Dental Services

There are a number of options people can tap into if they are either low-income or just trying to save as much money as possible.  Here are some options to consider:

  • At dental schools, students work on patients and are supervised by trained dentists. In exchange for giving students much needed experience, you will pay a low cost for appointments even if you have no insurance.  The American Dental Association has a list of dental schools you may be able to visit for services.
  • Dental clinics offer a sliding fee scale for patients who pay for services based on income. Some services may also be free.  You can find a local branch from national clinics such as the America’s Dentists Care Foundation if costs are a concern for you.  An online search should also reveal several possible options locally or you can check with your state dental society to see what options they may have.
  • With a discount dental plan, you will not need to make monthly premium payments and you can still get discounts on coverage. There are no annual caps or waiting periods for discount plans, but you should comparison shop to see what coverage is right for you.
  • If you are a military veteran, the U.S. Department of Veterans Affairs has two dental insurance programs for retired service members and their families. You must enroll in advance and pre-existing conditions are not covered without a waiting period.  Former service members may be eligible for VA dental care under Class IIA, IIC, IV, or I for any necessary treatment to maintain or restore oral health and masticatory function.  The VA Dental Insurance Program is available for enrollment beginning November 15 each year with coverage starting December 1.
  • Medicaid covers dental work for some adults and all children. There are no waiting periods for pre-existing conditions.  Families who meet eligibility criteria can enroll at any time but because this program is administered by individual states, coverage will vary depending on where you live.

Can I Get Full Coverage Dental Insurance with No Waiting Period?

Many people assume that once they are covered by dental insurance that most of their dental costs will immediately be covered, minus a small deductible.  Unfortunately, many of those same people get a rude awakening when they find out that most dental insurance plans include a waiting period which means you must wait a specified amount of time before you are covered for services.

The good news is that full dental coverage with no waiting period is available, but chances are there will be some caveats to your coverage.  You need to understand that just because full dental coverage is available, it does not mean that all of your costs are paid for.  Full coverage means that all major services are partially covered, but you will still need to pay some of the costs.

The percentage of coverage generally ramps up over a three-year period.  For example, in the first year of full dental coverage, a plan may cover 20% of the cost of major dental work after you meet your deductible.  In year two, this amount of coverage will increase up to 30% and then to 50% in the third year of coverage. Full coverage dental insurance with no waiting periods generally include a one-time deductible for as long as you are on the plan.

The other thing you need to be aware of when shopping for a plan with no waiting period is that annual maximum coverage amounts may come into play.  This means a plan will pay up to only a certain amount each year, and then the patient will be responsible for all of the overage amounts.  Plans with sliding increases in the percentage of coverage they offer may also increase the maximum annual amount each year as well.  If you are facing large dental expenses, this is a question you may want to ask when you are shopping for a plan.

Although you will still need to pay for a large majority of your dental work with a plan that offers no waiting period, you can still have major work done immediately and save some money in the process.  This may work best for patients who are in immediate need of major dental work such as crowns or dentures, those experiencing a lot of pain or may be missing prominent front teeth that cause them embarrassment, or someone who needs other work done as soon as possible to avoid a dental problem from growing worse and requiring even more costly work done at some point in the future.

Full service dental coverage may also provide exceptional value for parents of students who play contact sports.  Even using mouthguards, it’s not uncommon for high school football, hockey or lacrosse players to sustain blows to their mouths, resulting in lost or chipped teeth.  Waiting six months or more to replace or repair a damaged tooth or teeth is not viable at a time when children are still growing and developing.  Waiting too long can result in permanent damage or speech problems for children of all ages.

If no waiting period is a primary concern for you because you’re in immediate need of having major dental work done, then you do have a couple of options other than full coverage dental insurance.

  1. Some people opt for coverage through a Dental DMO. The trade-off is that you are required to use in network providers, but you are typically granted coverage for a wide variety of services.  You simply pay a one-time fee for the service you are seeking with no worries about waiting periods, deductibles or annual maximums.
  2. Other patients may choose to purchase a discount dental plan. This is not an insurance plan, but it can offer an affordable alternative when you use in-network dentists.  These types of plans generally charge a one-time annual fee instead of a monthly premium.  Instead of making a payment to an insurance provider, you make payments directly to a dentist.

In all cases, it pays to shop your various coverage options to see which one is right for you.

Can I Get Full Coverage Dental Insurance with No Maximum?

Yes.  In general, two types of dental coverage providers do not have an annual maximum.  They are Dental Health Maintenance Organizations (DHMO) and discount dental plans.

  1. Dental Health Maintenance Organization plans require you to choose a primary dentist from the sponsor’s network and you pay a fixed dollar amount for services. Preventative treatments such as cleanings are included in the premiums you pay.

 

  1. Discount dental plans entitle you to membership in a group that has negotiated discounted rates with a group of dentists. You pay for the services you receive plus an annual membership to belong to the plan.

Most all major dental insurers offer DHMO or discount plans, but coverage will vary by state.  Check with providers such as Delta Dental, Cigna Dental, Aetna, Humana or Careington to see if you can be covered under their offerings.

Where can I get Full Coverage Dental Insurance?

Many major dental insurers offer full coverage dental insurance.  You will need to decide which type of plan is right for your situation.  Dental plans fall into three main categories:

Indemnity or fee-for-service plans let you pick a provider and your insurer will pay a percentage of the dental provider’s fee.  These plans have the widest variety of choices in providers.  Deductibles will be lower and maximum amounts will be higher. This does mean that premiums will also be higher than with other plans

Preferred Provider Organization (PPO) plans allow you to pay lower fees to see in-network or preferred providers.  You aren’t required to do so, but you will save money by staying in-network.  With a PPO, some procedures may not be covered, or a waiting period will be required before coverage kicks in.  If you want some flexibility in which provider you see and don’t want to pay high premiums then a PPO may work best for you.

Health Maintenance Organization (HMO) plans require you to see providers in their specific insurance network.  Preventative services are covered 100% but basic services will come with some form of co-pay.  Premium payments are generally lower with an HMO.  You may not have a large choice of providers and restorative services will be covered at less than 50% if at all.

The best way to decide what full coverage dental insurance is right for you is to try and anticipate what services you or your family members might need, find out if there is a waiting period, and then shop for the package of benefits that best meets your individual situation.

What is the Best Full Coverage Dental Insurance?

The short answer to this is what ever plan best meets your needs for coverage, price, convenience, quality of service and overall value is the best full coverage dental insurance.

Just like any other important purchase, it pays to do your homework, talk to various providers, and to your friends and relatives to get input to help you decide.

You can also check out various review sites such as Top Ten Reviews which has recently published The Best Dental Insurance of 2018 on its website.