Teeth are having a good run at the Supreme Court this year. SCOTUS has handed down decisions in two cases involving oral health during 2015.

Children can continue to reap the benefits, including healthy, happy smiles.

Children can continue to reap the benefits, including healthy, happy smiles.

In one of those cases, decided at the end of February, the North Carolina State Board of Dental Examiners challenged a lawsuit brought by the FTC and lost. The suit alleged the board had violated antitrust laws by barring non-dentists from providing teeth whitening services at mall kiosks.

It’s nice to know the folks in North Carolina can now enjoy low-cost teeth whitening where they shop, but there’s some really great news for US kids.

Here it is: When SCOTUS ruled this month that the ACA’s premium tax credits were not just for those who used a state-based exchange, it also helped pave the way to good oral health and better access to dental care for children.

Pediatric Dental Health and the ACA

According to the CDC, while for the most part preventable, tooth decay is still the most common chronic disease among US kids. The ACA, though, still has a chance to turn that around thanks to the Court’s latest decision.

While the ACA – like the insurance industry in general – oddly cuts off oral health coverage from coverage for the rest of the body, it does require some dental coverage for some citizens. Dental insurance for adults is not required under the ACA, but subsidized health plans must address at least 10 types of health care, the essential health benefits (EHBs). These include oral and vision services for kids.

Including dental coverage for children in the ACA was a huge step in the right direction. With the Court’s new decision on consumers’ eligibility for tax credits, millions of children can continue to reap the benefits, including healthy, happy smiles.

Affordable Care and Your Oral Health

The ACA provides a number of ways to purchase dental coverage. Some states include oral care benefits for kids within the health plans available on their insurance exchanges. Others separate out dental coverage as standalone products.

States may also define oral care benefits for adults as part of the EHBs for their citizens. Some roll those benefits into the health plans they offer. Others offer them as standalone parts of the benefits package.

Greater Consumer Choice and Enrollment Availability

You can obtain private dental plans both on and off the government-run insurance exchanges. For broader plan selection and the ability to enroll in a plan at any time, many people turn to the private dental marketplace. People that recognize oral health is not really cut off from general health, often enroll in a separate, stand-alone dental plan after they enroll in marketplace coverage.

For example, DentalInsurance.com provides consumers across the US with access to a very wide selection of dental coverage options. These include traditional dental indemnity plans, dental health maintenance organization (DHMO) plans, preferred provider organization (PPOs) plans, and even discount dental plans or cards.

We’ve made it easy for you to find individual dental insurance, dental coverage for yourself plus one other person, or even dental coverage for your whole family. To compare dental plans available in your area, simply enter your zip in the box on our home page.

Hooray for SCOTUS and the ACA! Now, be sure to exercise your constitutional rights to life, liberty, and the pursuit of oral health!

Learn more about the ACA.

Dental Network Concept

There are many dental networks in the US. Specially contracted dentists make up each separate plan’s network.

Some people think buying dental insurance also means having to get a new dentist. The truth is, it depends.There are many dental networks in the US, and using a dental plan that has a network doesn’t always mean you will lose freedom of choice.

There are 4 basic types of dental plans: indemnity plans, dental health maintenance organizations (DHMOs), preferred provider organizations (PPOs), and discount dental plans. All but one of these types makes special arrangements with specific dentists to perform services at better rates for their plan’s members.

Those contracted dentists make up each separate plan’s “dental network.” There are dozens – if not hundreds – of dental networks today in the US.

Learn more about four types of dental plans.

Whether you will be able to keep your current dentist depends on the type of plan you choose.

The range of freedom depends on your choice of plan

Most dental plans restrict which dentists you can go to for services. On the side of free choice, you can see any dentist when you have an indemnity plan. At the other end of the spectrum, DHMOs and discount dental plans require that you only use their network dentists.

Then, there are PPO plans, the middle ground in the spectrum of dentist choice. Similar to DHMO and discount plans, PPO plans are built around a dental network. With many PPO plans, however, the use of out-of-network dentists may be allowed.

Then, there are PPO plans, the middle ground in the spectrum of dentist choice…

Depending on the PPO plan, you may be able to see a dentist who is not a member of the network and still have some part of your expenses covered or offset by the plan. The best savings, though, will always go to members who use an “in-network” dentist.

So if you’re one of those people who loves your dentist and wants to continue seeing them (we hope you are!), check with them to find out what plans and networks they take part in. If you don’t have a dentist yet, think about the other criteria that may be important to you, and choose a dental plan accordingly.

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Terminology-FeatureNeed a little help getting the most out of your dental insurance? Along with this blog, check out our Dental Resources. You’ll find sections on Dental Insurance 101, Dental Insurance Terminology, Insurance Types, and loads of articles about dental and oral care topics.

The section on dental insurance terms can be a big help if you are new to dental insurance. After all, we hear about “benefits” every day, but when speaking of dental insurance, the term has a special meaning. Then there are terms like “indemnity,” “coinsurance,” and “UCR,” which you may have no idea how to define, whatever the context.

Dental Insurance lingo: A crash course

Nearly 500 terms are explained in our glossary. But you don’t have to read them all to get your bearings in the world of dental insurance.

To help you master a few of the basics, here are twenty of the most frequently used terms you’re likely to see if you’re in the market for dental insurance.

Word of the Week: Alveolar

Alveolar

Administrator: One who manages or directs a dental benefit program on behalf of the program’s sponsor. (See Third-Party Administrator; Dental Benefit Organization.)

Benefit: The amount payable by a third party toward the cost of various covered dental services or the dental service or procedure covered by the plan. A related term, “Benefit Booklet” refers to a booklet or pamphlet which contains a general explanation of the benefits and related provisions of the dental benefit program.

Claim: A request for payment under a dental benefit plan or a statement listing services rendered, the dates of services, and itemization of costs. Includes a statement signed by the beneficiary and treating dentist that services have been rendered. The completed form serves as the basis for payment of benefits.

Coinsurance: A provision of a dental benefit program by which the beneficiary shares in the cost of covered services, generally on a percentage basis. A typical coinsurance arrangement is one in which the third party pays 80% of the allowed benefit of the covered dental service and the beneficiary pays the remainder of the charged fee. Percentages vary and may apply to table of allowance plans; usual, customary, and reasonable plans; and direct reimbursement programs.

Copayment: The Beneficiary’s share of the dentist’s fee after the benefit plan has paid.

Coverage: Benefits available to an individual covered under a dental benefit plan.

Deductible: The amount of dental expense for which the beneficiary is responsible before a third party will assume any liability for payment of benefits. Deductible may be an annual or one-time charge, and may vary in amount from program to program. (See Family Deductible.)

Dental Health Maintenance Organization (DHMO): Typically, the least expensive of dental plans. All dental services are provided by professional dentists who agree to provide specific treatments and services to patients at no charge (some services may require a co-payment.) DHMO plans reward participating dentists who keep patients in good health, thereby keeping plan costs low. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.

Eligibility Date: Often referred to as “effective date,” this is the date an individual and/or dependents become eligible for benefits under a dental benefit contract.

Exclusions: Dental services not covered under a dental benefit program.

Word of the Week: Gingival

Gingival

Indemnity Plans: Dental plans where a third-party payer provides payment of an amount for specific services, regardless of the actual charges made by the provider. Payment may be made either to enrollees or, by assignment, directly to dentists. Schedule of allowances, table of allowances, or reasonable and customary plans are examples of indemnity plans.

Limitations: Restrictive conditions stated in a dental benefit contract, such as age, length of time covered, and waiting periods, which affect an individual’s or group’s coverage. The contract may also exclude certain benefits or services, or it may limit the extent or conditions under which certain services are provided. (See exclusions.)

Maximum Benefit: The maximum dollar amount a program will pay toward the cost of dental care incurred by an individual or family in a specified period, usually a calendar year.

Patient: An individual who has established a professional relationship with a dentist for the delivery of dental health care. For matters relating to communication of information and consent this term includes the patient’s parent, caretaker, guardian, or other individual as appropriate under state law and the circumstances of the case.

Preferred Provider Organization (PPO): A formal agreement between a purchaser of a dental benefit program and a defined group of dentists for the delivery of dental services to a specific patient population, as an adjunct to a traditional plan, using discounted fees for cost savings.

Word of the Week: Veneer

Veneer

Reimbursement: Payment made by a third party to a beneficiary or to a dentist on behalf of the beneficiary, toward repayment of expenses incurred for a service covered by the contractual arrangement.

Schedule of Benefits: A listing of the services for which payment will be made by a third-party payer, without specification of the amount to be paid.

Subscriber: The person, usually the employee, who represents the family unit in relation to the dental benefit program. This term is most commonly used by service corporation plans. Also known as: certificate holder, enrollee.

Usual, Customary and Reasonable (UCR): A dental benefit plan that determines benefits based on “Usual, Customary, and Reasonable” fee criteria.

Waiting Period: The period between employment or enrollment in a dental program and the date when a covered person becomes eligible for benefits.

Ready to become a dental insurance power user? Get familiar with the entire list of glossary terms.

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Need dental insurance? Zip-Based Search Reveals: Dental Plans in All 50 States

“As a child,” the mush-mouthed comic Buddy Hackett used to say, “my family’s menu consisted of two choices: take it or leave it.”  If you’ve ever shopped for dental insurance, you know that, fortunately, when it comes to dental coverage, there are many more options available.

To make the choice easier, it helps to compare and contrast the 4 basic types of coverage that are available for dental care. With that in mind, here’s a brief overview:

DHMOs

Dental insurance types - many choices

Dental insurance is available through traditional plans, managed care, preferred provider organizations, and discount plans or “cards.”

A dental health maintenance organization or DHMO (a type of “managed care”) is a network made up of highly qualified dentists who provide comprehensive and affordable care for individuals or families. Consumers choose a dentist from the network, and they pay a low monthly premium to receive services at either no cost or a reduced price (some services may require a copayment). The participating dentists receive fixed monthly fees.

DHMOs offer some great benefits. For example, they are normally the least expensive type of dental coverage, and subscribers have no waiting periods, deductibles, calendar year maximums, or claim forms. DHMOs are convenient for people who can’t wait for the waiting period on their indemnity plan or PPO to be satisfied. In addition, participating dentists may refer subscribers to dental specialists, and subscribers can receive a discount for specialty services from participating specialists. (Learn more about DHMOs.)

PPOs

One of the most popular forms of dental insurance coverage is another type of managed care plan called a preferred provider organization (PPO). In this type of plan, consumers select a dentist from a network of preferred dental providers. The providers agree to provide dental care to members at reduced rates. PPO dental plan participants are assured of the maximum cost of their dental treatment in advance.

With a PPO, participating dentists have agreed to pre-negotiated fees. While the choice of dentists is somewhat limited, some PPO plans do provide the freedom to select an out-of-network dentist. In addition, after PPO members have used their maximum annual benefits, the costs for services still remain at pre-negotiated levels. (Learn more about PPOs.)

Indemnity Plans

If being able to choose from the largest pool of dentists is high on your list of priorities, you may be interested in indemnity plans. Individuals with indemnity insurance are free to visit any dentist, unlike those with managed care plans. Subscribers to this type of coverage, also known as “traditional” insurance, pay their dentist’s bill in full and then submit a claim for reimbursement to the carrier.

If being able to choose from the largest pool of dentists is high on your list of priorities, you may be interested in indemnity plans. 

Some key strengths of indemnity dental plans include the fact that indemnity plans typically cover a major part of the patient’s bill, and also that they help consumers plan ahead. Completing a pre-claim before having major services done lets consumers know up front what part of their bill the carrier will cover. (Learn more about indemnity plans.)

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Discount Dental Plans

Finally, while not “insurance,” discount dental plans (DDPs), also known as discount dental cards, are another type of coverage that can help consumers save on dental care costs. DDP members make monthly or annual payments in exchange for unlimited dental care services that are priced based on a discounted fee schedule. Services are provided by dentists who participate in the plan’s dental network.

Discount dental plans provide people who have no dental insurance with a cost-effective alternative. People can also use a DDP for services that are covered by one of the other types of insurance but unavailable due to a waiting period. Consumers can save up to 50% on dental work with a DDP compared to having no dental coverage. Moreover, the monthly or annual payments are usually a fraction of the cost people pay for other types of dental coverage. (Learn more about discount dental plans.)

Do you have questions about your dental insurance options? Learn more with the resources below, or leave a comment in the Reply section.

Learn More

  • Explore your dental coverage options and find answers to other questions about oral care in the Dental Resources section at DentalInsurance.com.
  • Download a free dental insurance checklist designed to help you pinpoint the best dental plan for your needs.
  • Dig into this infographic to learn more about the basic types of dental coverage available.