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Introduction to Dental Insurance

By Mark Bailey, Jr.
Published April 28, 2017


Aside from protecting that beautiful smile of yours, dental care ensures good oral and overall health – hence the obvious importance of having dental insurance.

Several studies suggest that oral diseases, such as periodontitis (gum disease), can affect other areas of your body—including your heart. I had to learn this the hard way in my early teens. My gums would literally bleed whenever I went to get my teeth cleaned. I though the hygienist was crazy when she suggested that my gum disease could lead to heart problems later in life. But, it’s true. Study after study has suggested that the health of your mouth plays a key role when it comes to the health of the rest of the body.

Understanding your options when it comes to dental coverage will help protect you and your family from the high cost of dental disease and surgery (should things ever get to that point).

What is Dental Insurance

Dental coverage is very similar to traditional medical insurance and is one of the voluntary benefit options commonly offered through employers. When buying an individual health insurance plan, dental insurance can be obtained in 2 ways:

  1. By buying a health insurance plan from the Marketplace that comes bundled with dental coverage.
  2. By buying a stand-alone dental plan separate from your health insurance plan (yes, in this case you’ll end up paying 2 premiums instead of just 1).

Just like health insurance, you pay a premium and then your insurance will cover part or all of the cost for many dental services. Also similar to health insurance, dental coverage is offered in several types of plans:

  • Dental Health Maintenance Organization (DHMO): Coverage is only provided when you visit dentists who are in- network with the insurance plan.
  • Dental Preferred Provider Organization (DPPO): Coverage is provided with in- or out-of-network dental care providers, but you will typically pay less with an in- network dentist.
  • Dental Indemnity Plan: Coverage is provided for any dentist you choose, with no difference in cost.
  • Discount dental plan: This type of plan is a common option for reducing dental costs without regular insurance coverage; with this plan, you pay for all your dental care at an agreed-upon discounted rate.

Why Should I Have Dental Insurance

There’s a pretty obvious answer to this question. Professional dental care can diagnose or help prevent common dental problems including toothache, inflamed gums, tooth decay, bad breath and dry mouth. If conditions like these remain untreated, they can worsen into painful and expensive problems such as gum disease or even tooth loss. According to the American Dental Association, more than 16 million children in the United States suffer from untreated tooth decay, which is the most common chronic childhood disease.

Regular dental exams can not only treat dental problems but can also identify other serious health concerns, including some types of cancer.

Dental coverage will allow you to inexpensively receive preventive and diagnostic care from your dentist.

How the Affordable Care Act Changed Dental Insurance

Under the Affordable Care Act (ACA), dental services are an essential health benefit for children under the age of 18. That means that dental coverage must be available for your child either as part of a health plan or as a stand-alone plan. While dental coverage must be available to your children, you don’t have to buy it.

Unfortunately, the essential health benefit status for dental coverage does not apply to adults. In addition, unlike medical insurance, you do not have to obtain dental coverage to avoid penalties from Uncle Sam come tax time.

Mark Bailey, Jr. is the Senior Marketing Manager of NFP's Atlantic region. Before joining the company, Mark was a production assistant on the tv show Glee and an on-air talent on 95.1 WAPE. He has over 10 years of experience in the insurance and corporate benefits space. Mark is an avid Jacksonville Jaguars fan and loves to spend his free time building custom mechanical keyboards.