If you are in the market for dental coverage in North Carolina, you’ll increase the odds of getting the right plan for your needs if you understand:
The below information will help you quickly learn what you need to know and share some cost trends observed among North Carolina dental plans.
Dental benefits are not a one-size-fits-all product. There are several options from which to choose and they each have their own strengths and weaknesses. The main options available in the state are:
Traditional dental insurance is similar to medical insurance. In exchange for the payment of a monthly premium, an enrollee receives coverage for a predetermined list of services. For a DHMO (a dental health maintenance organization) insurance plan, the enrollee must obtain dental care from a dentist (or related specialist like an oral surgeon) belonging to the DHMO’s network. Out-of-network care is typically not covered. A dental preferred provider organization (DPPO) insurance plan, in contrast, does have out-of-network coverage but at higher out-of-pocket costs for the enrollee.
Indemnity plans do not have a network so the enrollee can use whichever dentist he or she prefers. However, an indemnity plan does not work like insurance. The enrollee pays for dental care at the time of service and then receives a reimbursement for the indemnity plan. Moreover, the reimbursement level is fixed regardless of what the dentist charges so there can be a considerable difference between what the dentist charges for care and what the indemnity plan pays.
A dental discount program has some similarities with the previous two options discussed. Like a DHMO plan, it employs a network of dentists. Like an indemnity plan, it is not insurance but a different form of dental benefits.
An examination of a dozen and a half North Carolina dental plans found that premiums were as low as $8.95 a month in 2021, and as high as $68.72. The least expensive was a discount program and the most expensive was an indemnity plan. The remainder of the plans whose data was available for study were DPPO plans.
The majority of plans reviewed paid 100% for dental cleanings. A few charged the enrollee 20% of the service cost and the dental discount plan charged $45 for the service.
The maximum amount a plan would pay in a year for an enrollee’s dental care varied substantially from one plan to another. The one discount card within the group had no limit on the discount savings it provided. The remainder had monetary limits. The most generous plan, Renaissance’s MAX Choice Plus, had a maximum annual benefit of $3,000, but this was only available in the third year of enrollment. In the first year, the maximum benefit was $1,000 and that maximum rose to $2,000 in the second year of enrollment until reaching the $3,000 figure for the third year and beyond.
About one-in-five plans had a maximum benefit of $2,000. Most plans, though, had maximum benefits below that amount.
The state of North Carolina passed the "NC Dental Society's Dental Bill of Rights " into law. This recent legislation:
The North Carolina Dental Society includes more than 3,900 member dentists. The website can help you find a local dentist as well as file a complaint if you have objections about the quality or appropriateness of dental treatment you received.
Get answers to a variety of questions. Topics range from informational discussions like “Can I go to the dentist while pregnant?” and “3 Things your dentist wants you to know about the COVID-19 vaccine” to immediate needs such as “What happens if I knock out a tooth?” and “How do I treat a toothache?”
This resource lists free and low cost dental services across North Carolina. The North Carolina Missions of Mercy Foundation has set dates for free dental clinics to be held in Wilmington, High Point, and Gastonia.
Esse quam videri (To be rather than to seem)
No waiting periods. Increasing benefits. Get the most out of this plan by using one of our 115,000 network providers.
Plan type: PPO
Plan Maximum: $1500
100% preventive coverage on day one. $2000 plan maximum. No waiting periods.
Plan type: PPO
Plan Maximum: $2000
Designed for people who are looking to maintain their oral health through regular dental exams and cleanings
Plan type: PPO
Plan Maximum: $1000