What is dental insurance?

It doesn’t take long for tooth pain to nudge someone to a dentist. In addition to helping pay for treatment to alleviate tooth pain, dental insurance can help reduce costs to maintain healthy teeth and gums. Dental insurance is a policy (with a monthly cost) that helps pay for qualified dental care. Understanding dental plans and terminology can help minimize costs.

What are some common types of dental insurance?

Dental plans can vary in provider networks, deductibles, monthly costs and other components. Three common dental plans include:

Dental Preferred Provider Organization (DPPO) Plan: Dentists contract with the dental insurance carrier to form a network and offer services at discounted rates. Choosing a dentist within this network reduces out-of-pocket costs. Plan members can use providers outside the network, but it generally costs more. This type of plan usually has an annual deductible, co-insurance and an annual maximum coverage amount.
Dental Health Maintenance Organization (DHMO): A DHMO typically has lower monthly costs than PPO plans and requires the plan member to select a primary dental facility. Referrals are required to see a specialist, and there is no coverage for out-of-network dentists. This plan often has co-pays (a set fee) for dental services and typically does not have a deductible or annual maximum amount.
Dental Exclusive Provider Organization (DEPO) Plan: This managed care plan covers dental services only within the plan’s network (except in emergencies). Referrals are not required to see specialists.

What’s the meaning of dental insurance terminology?

Understanding dental insurance terms can help with plan comparison, maximizing benefits and minimizing costs.

Co-pays: This is a flat amount a plan member pays for a dental service.
Deductible: This is the amount a plan member pays out-of-pocket before the plan’s co-insurance kicks in. The lower the deductible, the more the dental plan typically costs.
Co-insurance: This is the amount a plan pays for eligible services after the deductible is met. For example, a plan may have 80%/20% co-insurance. This means that after the deductible is met, the plan will pay 80% and the plan member will pay 20% of future costs.
Annual maximum: This is the most a dental plan will pay for the year. A higher monthly premium may offer a higher yearly maximum. Once the maximum is met, the plan member is responsible for 100% of dental costs for the rest of the year.
Waiting period: Some dental plans require members to wait three to 12 months before covering services (preventive services are not usually subject to this waiting period).

Is dental insurance worth it?

Dental plans can help ease the costs associated with dental care and treatment. They can help:

Pay for qualified dental expenses: What does dental insurance cover? There are generally three tiers of dental services:
- Preventive: Cleanings, X-rays and oral screenings
- Basic: Fillings, root canals, tooth extractions and gum disease treatment
- Major: Crowns, bridges and dentures
Minimize costs: In-network dentists agree to charge rates typically lower than providers outside the network.
Offer preventive care: Routine services such as cleanings and X-rays are often provided at no out-of-pocket cost to the plan member.

How can someone get dental insurance?

Dental plans may be accessible through:

An employer-sponsored dental plan: Some employers offer a dental plan and may pay a portion of the monthly cost to help reduce employee costs.
A spouse’s or parent’s plan: Spouses or dependents under age 26 may be able to enroll in a spouse’s or parent’s plan through their employer.
The Marketplace: The Marketplace, operated by the federal government, offers dental plans built into health plans and as separate dental plans.¹
COBRA (Consolidated Omnibus Budget Reconciliation Act): Through this federal law, existing dental coverage may be continued for those who have experienced qualifying events, including termination of employment (for a reason other than “gross misconduct”) or a reduction in work hours.²
Private plans: Private insurance companies may offer individual dental plans (not based on employment).
GuideStone^®: Those eligible for GuideStone dental plans include paid employees working 20 or more hours per week at an eligible church, agency or institution affiliated with or that shares common religious bonds with the Southern Baptist Convention^®.
Clinics and dental schools: Some community health centers and clinics offer low- or no-cost dental services if you can’t afford dental coverage. Local dental schools may also offer reduced rates.

What should be considered when selecting a dental plan?

Evaluate anticipated dental needs, plan coverage and pricing to determine which plan fits best.

What types of dental care are anticipated?
Some people do not typically need extensive dental care and may mainly utilize preventive care such as routine cleanings twice a year. Others may require multiple fillings, crowns or bridges. Evaluate the plan deductible, co-insurance and annual maximum to calculate the estimated out-of-pocket expenses based on those needs. The lower the deductible, the more the dental plan typically costs.
Is orthodontia covered?
Not all plans cover orthodontic treatments such as braces, aligners and retainers. If you need these services, search for a plan with coverage.
Which dentists are in-network?
Check the plan’s list of in-network dentists to see how many options there are and whether a preferred dentist is available.
Is there a waiting period?
Does the plan have a waiting period for some dental services? If so, consider whether those services may be needed sooner than the waiting period expires and how that may impact out-of-pocket expenses.
What is the plan’s annual cost?
Multiply the plan’s monthly cost by 12 to get the yearly cost. Remember, this is the cost of having the plan, not using it.

How can dental care costs be minimized?

To save money on dental expenses, take advantage of preventive care benefits such as bi-annual cleanings and X-rays to minimize the risk of issues requiring more extensive and costly treatment. For plans with networks, select in-network dentists for the lowest costs for services. If eligible, pay for qualified dental expenses with pre-tax money from a Health Savings Account (HSA).

Start Well. Stay Well. Finish Well.™

At GuideStone, we advocate for your well-being in all seasons of ministry with dental plans, tips to save on prescription medications, encouragement to honor what the Bible says about our physical health and much more. For more information, contact us at Insurance@GuideStone.org or 1-844-INS-GUIDE (1-844-467-4843), Monday through Friday, from 7 a.m. to 6 p.m. CT.

GuideStone welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as legal advice or medical advice, diagnosis or treatment.

¹HealthCare.gov/coverage/dental-coverage
²DOL.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/an-employees-guide-to-health-benefits-under-cobra