Dental Insurance
The Importance of Protecting Your Smile
Your smile is one of your most important assets, and taking care of your teeth and gums is crucial for maintaining good oral health. While regular dental check-ups and cleanings can help prevent problems, unexpected dental issues can arise, leading to significant expenses. This is where dental insurance comes in – a type of insurance designed to cover the costs of dental care and help you maintain your beautiful smile
Average Dental Insurance Cost:
Americans pay about $360 a year, or between $20 and $50 a month. In Oregon, it starts as low as $18.50.
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Oregon Dental Insurance Plan Options
Dental insurance is a type of insurance that helps cover the costs of routine dental care and unexpected dental expenses. It can include coverage for things like regular check-ups, cleanings, fillings, and extractions, as well as more extensive procedures like root canals and crowns. Having dental insurance can help you and your family maintain good oral health and prevent more serious and costly dental problems down the road.
Most dentists allow those without dental insurance to apply for Care Credit. It helps pay for out of pocket expenses. Care credit offers healthcare financing to pay for deductibles and out of pocket healthcare and dental costs.
Dental insurance is designed to pay a portion of the costs associated with dental care. It helps cover preventative services and major dental work such as fillings, root canals, dental x-rays, braces and teeth extractions.
Best Dental Insurance Plans
Spirit Dental Insurance
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NO waiting period
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3 Cleanings per year
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$5,000 annual maximum
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Choose your own dentist
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Guaranteed accceptance
Nationwide Dental
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NO waiting period for preventative & basic services
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PPO Plan
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Enjoy discounts, rewards, and perks on thousands of the brands
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You can add vision
ODS - Moda Dental
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Big network of dentists
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Cleanings every 6 months
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Superior Customer Service
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6-12 months waiting period for major work
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PPO and HMO plans
Surebridge
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A large network of dentists
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PPO plan
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Affordable premiums that don’t go up
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100% for preventative services
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Waiting period
SMILE, your future never looked so good!
Types of Dental Insurance Plans
Members receive some discounts on dental workIndemnity or fee-for-service plans-These allow you to pick a dental provider and your plan pays a percentage of the provider’s fee.
These allow you to pay lower copays to see certain in-network or “preferred” providers.
HMO dental plans require you to see dental providers in the insurance network. Timing is very important. In general, adults need to see the dentist every 6 months. Your dental health policy may pay for a preventive visit every 6 months or twice per calendar year, or twice over a 12-month period. There are also time limits on certain dental services such as fillings on the same tooth, bridges, crowns, x-rays and fluoride treatments. For example, your dental plan may pay for a full series of x-rays only once every 2 years.
How to Maximize your Dental Insurance
- It’s important to carefully review your dental policy to determine if a certain dental procedure is covered.
- You can always call your insurer to verify coverage.
- For major dental procedures, it’s wise to ask your dentist for a pre-dental service estimate. This is to determine how much you’re responsible to pay.
- For dental emergencies, it is best to understand any provisions your dental plan has to offer for urgent care.
Medicare and Dental Insurance
Dental insurance in Oregon can vary greatly in terms of cost and coverage. Some of the best affordable dental insurance options include plans offered by companies such as Delta Dental, Moda Health, and Willamette Dental Group. These plans typically offer a range of coverage options and can be customized to fit your specific needs.
In addition, there are also affordable dental insurance plans available through Medicare. These plans, known as Medicare Advantage plans, can provide additional coverage for dental services such as cleanings, fillings, and extractions. Overall, it is important to research and compare different dental insurance plans in order to find the one that best fits your budget and dental needs.
Timing is very important!
In general, adults need to see the dentist every 6 months. Your dental health policy may pay for a preventive visit every 6 months or twice per calendar year, or twice over a 12-month period. There are also time limits on certain dental services such as fillings on the same tooth, bridges, crowns, x-rays and fluoride treatments. For example, your dental plan may pay for a full series of x-rays only once every 2 years.
What do Dental Plans Cover?
Typically, dental insurance covers some of the costs for
- preventive care, fillings,
- crowns,
- root canals,
- and oral surgery (such as tooth extractions).
- Orthodontics,
- periodontics (tooth support structures),
- and prosthodontics (dentures, bridges)
- Usually, two preventive visits per year are included.
Individual policies may not cover periodontics or prosthodontics in the first year, and orthodontics often requires an additional fee (rider).
Common plans have a coverage structure of 100-80-50, meaning preventive care is covered at 100%, basic procedures at 80%, and major procedures at 50% with higher co-payment. However, some procedures may not be covered, such as sealants.
Benefits of Dental Insurance:
Preventive care: Dental insurance plans typically cover preventive care such as regular check-ups and cleanings, which can help prevent oral health problems from developing.
Reduced costs: With dental insurance, you’ll save money on the cost of dental procedures, from routine check-ups and cleanings to more complex procedures such as root canals and dental implants.
Improved oral health: With access to affordable dental care, you’re more likely to get the dental treatments you need to maintain good oral health. This can help you avoid painful and expensive dental problems in the future.
Limitations of Dental Insurance Plans
Each plan has a limit on its yearly payment, often referred to as the annual maximum. This amount is usually low, with half of dental PPOs offering annual max of less than $1,500. Any expenses beyond this limit are the responsibility of the policyholder. Major procedures such as crowns, root canals, or oral surgery can easily exceed the annual maximum.
Orthodontic costs usually have a separate lifetime maximum.
Some plans may exclude certain services to reduce costs, so it’s important to know what services are covered and excluded by your plan.
Most dental insurance plans have limitations and exclusions to control cost but not penalize the patient. For example, experimental procedures and services not performed by a dentist are typically excluded. It’s crucial to read and understand your dental insurance plan as there may be overlap with medical insurance coverage. Exclusions in your dental plan may be covered by medical insurance.
Things to Consider when Choosing a Dental Plan
If your employer offers dental insurance, that’s an economical option. If you’re shopping for your own plan, your dentist may recommend a plan based on your dental history. Consider the following while comparing plans:
- If your dentist and any specialists are in network
- Total yearly costs (premiums, co-pays, deductibles)
- Annual maximum
- Out-of-pocket limit (if any)
- Limitations on pre-existing conditions
- Braces coverage (if needed or planned)
- Emergency treatment coverage (including away from home)
- Ability to choose your own dentist
- Who makes treatment decisions (you/dentist or insurance plan)
- Coverage for diagnostic, preventive, and emergency services
- Routine treatment coverage
- Major dental care coverage
- Availability and convenience of appointments
- Eligibility for coverage and effective date.
How does Dental Insurance Work?
Dental insurance works the same way as medical insurance. Monthly premium vary among dental carriers. You will receive certain dental benefits, normally free or minimum co-pay on annual checkups, cleanings and x-rays. Most dental plans have 6 to 12 month waiting period to cover major services such as crowns, extractions, fillings, dentures, and braces. But some do not have restrictive waiting periods. Coverage could start the very next month upon enrollment. Some plans provide broader coverage than others and some will require higher copays. Some plans may also offer coverage for certain types of oral surgery, dental implants, or orthodontia.
Oregon Dental Insurance Plan Structure:
Most dental insurance plans have the 100-80-50 coverage structure, meaning that for preventive care your plan will cover 100% (dental exams, cleanings, and X-rays) for basic procedures it will cover 80% (fillings, extractions, and periodontal work) and for major procedures it will cover 50% (crowns, root canals, dentures, bridges and implants). In addition, most plans have an “annual maximum” on what it will pay during the entire plan year. If you go beyond this cap, you’re responsible for the rest of the cost. Some Oregon dental plans don’t have a cap or maximum out of pocket. These work best if you’re in need of considerable dental work.
FAQs on Dental Insurance:
What is covered by dental insurance? Dental insurance typically covers preventive care such as regular check-ups and cleanings, as well as more complex procedures such as root canals, dental implants and orthodontic treatment.
Is it mandatory to have dental insurance? No, dental insurance is not mandatory. However, it is highly recommended, as dental care can be expensive and without insurance, you may have to pay out-of-pocket for all dental procedures.
Can I choose my own dentist with dental insurance? It depends on the type of dental insurance you have. If you have a DHMO, you must choose a primary care dentist from the network. If you have a PPO, you can see any licensed dentist but you may pay more for seeing an out-of-network provider.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
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