Supplemental dental insurance is a plan that helps fill the gaps in your existing individual or employer dental insurance coverage. Some services this dental insurance may pay for include:
- Major or minor dental restorative services such as fillings, denture repairs, extractions, and oral surgery
- Preventive care procedures such as annual cleanings and X-rays
- Orthodontic treatments
There are two main types of supplemental dental insurance: managed care and indemnity. Managed care plans require you to visit a specific network of dentists to receive coverage, whereas indemnity plans let you access any dentist. However, you may have to pay more out of pocket in exchange for the freedom to choose your preferred medical provider with an indemnity plan.
Table of Contents
- Why Do People Need Extra Coverage For Dental Services?
- How Does Supplemental Dental Insurance Work?
- What Types of Supplementary Dental Insurance Are Available?
- How Does Supplementary Dental Coverage Work For Medicare?
- Do I Need Supplemental Dental if I Already Have Coverage?
- Supplemental Dental Care Costs
- Should You Get Supplemental Dental Insurance?
- How To Get Supplemental Dental Insurance
- Putting It All Together
Why Do People Need Extra Coverage For Dental Services?
An estimated 76.5 million (22.5%) Americans do not have dental insurance, and many of those with Medicare report that their current dental coverage is insufficient to maintain their oral health.
Not having sufficient dental coverage can lead to unmet oral health needs and result in serious consequences, such as tooth loss, gum disease, and expensive emergency dental procedures. If you’ve been postponing your dentist visit due to inadequate dental coverage, it may be time to consider adding extra coverage to your existing dental insurance. Doing so can help you better manage your oral health and avoid hefty medical expenses down the line.
How Does Supplemental Dental Insurance Work?
Supplemental dental insurance can provide reimbursement for dental treatment when your primary plan falls short of your needs. Typically, your primary insurance will pay out first, and then your supplemental insurance will cover the gaps. Each plan will vary in what services it covers, so be sure to review your policy carefully.
Who Needs Supplementary Dental Insurance?
Dental care can come at a hefty price without proper coverage. The cost of a crown could be upwards of $1,500 without insurance, and dental implants could cost even more. To avoid exorbitant fees should you need any dental work done, consider purchasing secondary dental insurance if you have any of the following situations:
- Your employer does not offer dental insurance.
- Your current dental insurance has limited benefits.
- Your primary dental insurance does not cover a specific dental procedure you need, such as orthodontic treatments.
What Services Are Covered?
- Preventive Care. Most supplemental insurance providers will typically offer preventative care plans that cover regular exams, cleanings, and X-rays to help your risk of developing severe dental issues in the future.
- Minor or Major Restorative Procedures. Primary dental insurance policies typically limit coverage to $1,000 to $1,500 a year, which may not be enough for more expensive restorative procedures such as fillings, crowns, and bridges. With this additional dental insurance, you can afford these dental services without overextending yourself financially.
- Orthodontic Services. Orthodontic treatments, such as braces, can cost upwards of $10,000 without insurance. While not all primary dental insurance covers orthodontic services, many supplemental dental plans offer coverage specifically for braces and other orthodontic treatments.
- Dental Prostheses and Implants. Some secondary dental plans may also provide partial or full coverage for dental prostheses and implants to help you restore lost teeth.
What Services Are Not Covered?
Supplemental dental insurance plans typically will not cover cosmetic treatments that are not medically necessary, such as:
- Teeth whitening
- Dental bonding
- Gum reshaping
However, every insurance provider is different, so check with them first to see whether they will cover your desired dental procedure.
How Does Payment Work?
Suppose you have both primary and supplemental dental insurance. In that case, your primary insurance provider will typically cover part of the costs, and your supplemental insurance provider will help cover either a portion or all of the remaining balance on your dental bill. However, it’s important to note that secondary dental insurance providers will not accept a claim until your primary plan has paid its share. This process is also known as the coordination of benefits (COB).
For example, if you had a porcelain filling procedure that cost $1,200. You must wait until your primary dental insurance finishes paying a portion (ex: $600) of the dental bill until you can submit a claim to your secondary dental plan to cover the rest.
Where To Buy Supplemental Dental Coverage
There are a few places you can purchase additional dental insurance plans to ensure you have the coverage you need for dental care.
- Employer-Sponsored Plans: Some employers include supplemental dental insurance in their benefits package. Check with your employer to see whether you’re eligible for additional dental coverage.
- Individual Plans: Even if your employer does not provide supplemental dental insurance, you could still purchase an individual plan independently. You can typically purchase individual supplemental plans from private insurance companies or brokers.
- Marketplace Plans: Besides employer-sponsored and individual plans, you could also obtain additional dental coverage through the Health Insurance Marketplace. The Health Insurance Marketplace is a service the federal government provides that allows people who meet specific income requirements to enroll in affordable health insurance plans.
What Types of Supplementary Dental Insurance Are Available?
Most supplemental dental plans fall into two categories: indemnity and managed care. The type you choose may affect the number of dental care providers you have access to, your out-of-pocket costs, and how your bills are reimbursed.
An indemnity or fee-for-service plan is a type of insurance that allows you to receive dental services from any provider of your choice without being limited to a network of dentists. However, with this plan, you may have to pay your dental visit costs upfront and then bill your insurance company, which will reimburse you for a portion of the charges. Note that you may need to pay a certain deductible before the insurance company pays for coverage. Indemnity plans can cover a variety of dental services, including annual exams, root canals, tooth extractions, X-rays, etc.
Unlike indemnity plans, managed care requires you to use the plan’s dental provider network to receive coverage. In return, you’ll enjoy reduced rates for your dental procedures. And instead of submitting claims yourself, the dentists in the network will typically submit claims to the dental insurance company on your behalf, which means you’ll have less paperwork. What’s covered by your managed care plan can vary depending on your insurance provider, but it could include preventive, diagnostic, and restorative dental treatments.
How Does Supplementary Dental Coverage Work For Medicare?
If you have Original Medicare (Medicare Part A and Part B), you may need supplemental dental coverage since Medicare does not typically cover dental expenses related to routine care. To get the coverage you need, you could purchase a dental plan through private insurance companies or enroll in a Medicare Advantage (Part C) plan, which is a bundled plan that typically includes dental, vision, and hearing coverage.
Some types of Medicare Advantage plans may also have supplemental benefits you can purchase for an additional premium to boost your dental coverage. However, you can only join the Medicare Advantage program during the enrollment period. The Medicare website is a great place to start shopping for Medicare Advantage plans since you can use the ‘Find a Medicare Plan’ tool to generate a list of available plans.
Do I Need Supplemental Dental if I Already Have Coverage?
While you may already have dental coverage through your employer or a dental plan you purchased, there may still be scenarios where you could consider supplementing your coverage.
For example, suppose you plan on getting braces or extensive dental work done. In that case, your current coverage may only cover some associated costs, especially since most primary dental plans limit coverage to around $1,500 a year.
So, if you anticipate visiting your dentist frequently in the near future, supplemental dental insurance could safeguard your finances by reducing your burden of dental expenses.
Supplemental Dental Care Costs
If you’re considering supplemental dental insurance, here’s how much you could expect to pay for premiums, out-of-pocket costs, copays, and coinsurance.
Your supplemental dental insurance premiums can vary depending on your location, the insurance company, and the level of coverage you choose. Premiums for indemnity plans can range from $20 to $60 a month for a single person and anywhere from $50 to over $100 for families. Managed care plans are typically more affordable and can be as low as $9 a month for individuals and $20 a month for a family of three.
To receive supplemental dental coverage, you may have to pay out-of-pocket costs depending on your chosen plan. For indemnity plans, you may be required to pay the dental services upfront until you’re reimbursed for a portion of it later on. However, you typically would not be reimbursed for 100% of the dental service cost since your insurance provider may require you to pay a deductible and coinsurance. On the other hand, managed care plans require less out-of-pocket costs. You may only have to pay a low percentage of the coinsurance or copayment fee to receive coverage.
Most indemnity and managed care plans require a copay, a flat fee you pay on the spot every time you visit your dentist. It’s typically the same amount regardless of the cost of the dental work you’re receiving. Besides copays, you may also be responsible for paying coinsurance.
Coinsurance is the portion of your dental bill not paid by your insurance company, and it’s usually set as a percentage. For example, if you have a coinsurance responsibility of 20%, you’ll pay 20% of the dental treatment cost, and your insurance plan will cover the remaining 80%. Coinsurance is usually paid to your dentist at the time of the service, even after you’ve reached your deductible amount. Check your insurance policy to understand your coinsurance responsibility for each type of dental service.
Should You Get Supplemental Dental Insurance?
Supplemental dental insurance could safeguard your health and your finances if your existing policy does not cover the dental procedure you need or if you’ve already exceeded the policy’s annual maximum coverage limit. However, like any other insurance product, these dental plans also have their pros and cons.
- More comprehensive dental coverage: Traditional dental insurance policies typically limit coverage to around $1,500 a year and would not cover specific dental treatments such as braces. By purchasing supplementary dental insurance, you can afford these services and receive the dental care you need.
- Flexibility in choosing providers: If you opt for indemnity coverage, you can visit any dentist you want without being restricted to a network of oral health care providers.
- Lower out-of-pocket costs: This insurance can help cover some or all of the remaining balance on your dental bill after your primary dental insurance has paid a portion of it.
- Extra costs: Having supplemental insurance in addition to your primary dental insurance plan means you must pay two premiums to receive coverage. If you’re on a tight budget, this extra expense could become unmanageable.
- Complex claims process: Handling claims from two different dental insurance companies can be confusing and could result in mistakes or delays.
How To Get Supplemental Dental Insurance
There are a few steps to take when choosing a supplemental dental insurance policy:
- Determine your needs. Before purchasing supplemental insurance, take an inventory of your current and potential future dental coverage needs so you know what plans are most suitable.
- Research your options. Take the time to research various options by comparing deductible amounts, waiting periods, coverage, premiums, out-of-pocket costs, reputation, and customer service.
- Read the fine print. Once you’ve decided on an insurance provider, read the fine print so you’re aware of any exclusions and limits unique to your contract.
- Make sure your provider takes the dental insurance. If you have a specific dentist that you visit, check with them first to see if they’ll accept the insurance plan before you purchase it.
Putting It All Together
With a supplemental dental insurance plan, you could have peace of mind knowing that unexpected dental expenses would not derail your budget. To find the best insurance plan for your unique situation, perform your due diligence and comparison shop before settling on an insurance provider.