Dental Insurance

This type of supplemental insurance is designed to cover dental care expenses. Dental insurance can be offered as part of a medical insurance policy or as a stand-alone plan.^[3]
A dental insurance plan may be set up as an indemnity plan, a preferred provider organization (PPO) plan, or a health maintenance organization (HMO) plan.^[4]
Dental insurance can help you pay for costs related to maintaining good oral health, which studies indicate can positively impact your overall health.^[5]

No, adult dental plans are not qualified health plans under the terms of the Affordable Care Act (ACA).
The ACA lists dental coverage as an essential health benefit for children under age 18; however,^[3] this means if you purchase an ACA-compliant health insurance plan, dental coverage must be available for a child on your plan as either part of that plan or as a separate dental plan.
Currently, the ACA does not consider dental coverage to be an essential health benefit for adults age 18 and over, nor does it require insurers to offer adult dental coverage.^[4] Effective January 1, 2027, individual states will be allowed to designate whether to require insurers to offer non-pediatric dental coverage as an ACA essential benefit for adults.^[5]

Anyone who is interested in having good oral health, and wants to receive covered dental procedures at no-cost or at a reduced cost should think about purchasing a dental insurance policy.
Dental insurance is guaranteed issue, which means that all applicants over age 18 are accepted regardless of health history.
Learn more about dental insurance for kids and families, and dental coverage for seniors.

Your dental insurance premiums are calculated based on factors such as:
●        The plan structure (indemnity, HMO or PPO)
●        The coverage level you select
●        Your age
●        Your location
●        How many people are covered on the plan
Some dental insurance plans have annual deductible options, which may be a way to limit out-of-pocket costs related to your oral health based on plan selection.
Find plan options available to you and compare premium costs and coverages by getting a dental insurance quote. Or call (888) 855-6837 to speak with a licensed agent at IHC Specialty Benefits.

Dental insurance typically covers the four categories of services with a 100/80/50 plan payment structure:**
Service
Typical Payment
Preventive – cleanings and check-ups; fluoride treatments for children
100%
Diagnostic^ – bitewing x-rays (every 6 months) full-mouth x-rays (every 3 years)
100%^
Basic – fillings, extractions
80%
Major – root canals, crowns and bridges
50%
** For general informational purposes only. Read policy details, exclusions and limitations before purchasing a plan.
^ Under some plans, diagnostic services are paid at 80% and subject to a waiting period
Dental plans typically do not cover cosmetic procedures, orthodontics, implants, dentures, oral care related to a medical condition, prescription medication and pre-medication for pain. Your plan also will not cover expenses in excess of the plan’s annual maximum benefit.
Remember, you must read any policy you’re considering carefully to understand what is covered and what is excluded. And often, waiting periods apply for procedures that aren’t considered preventive care. The above lists are only examples.
Call (888) 855-6837 for more details about available plan options. Or you could research the costs of common dental procedures and decide if dental insurance could be helpful for you.

Dental insurance provides a benefit payment for a designated set of covered procedures related to teeth and gums, as outlined in your plan’s Schedule of Benefits. Reviewing your Schedule of Benefits enables you to plan how and when to receive care by showing:
●        What services are covered
●        What your out-of-pocket costs will be
●        Whether benefits vary based on selecting an in-network or out-of-network provider
Depending on the plan you select, your policy may include:
●        Annual maximum – the maximum amount your plan will pay towards covered services in a calendar year
●        Copay – a fixed amount you pay each time you visit your dental provider
●        Coinsurance – the portion of each covered service for which you are responsible to pay
●        Deductible – the amount you must pay before the plan provides payment for covered services
●        Waiting period – the amount of time you must wait before your plan will pay for diagnostic, basic and/or major dental procedures. Waiting periods vary by state.
Note that routine preventive services, such as exams and cleanings, may not be subject to your plan’s deductible. Learn more about how dental insurance works.

Depending on the dental insurance plan you select, you may need pre-authorization before obtaining dental services beyond preventive care. Generally, if you need major services, you can ask your dentist to submit a proposed treatment plan to your insurance company. That can help you determine what your out-of-pocket costs for services will be. If you have additional questions, be sure to contact your insurance company for specific details about your plan benefits.

A PPO dental plan offers a network of dental providers. If you visit an in-network provider, your out-of-pocket costs are typically lower.^[2] That’s because dentists within the network have agreed to a negotiated dollar amount for each covered charge with your insurance company.
Out-of-network dentists may charge fees either higher or lower than what the insurance plan allows; excess fees are usually your responsibility to pay.
Typically, an HMO dental plan covers – meaning pays benefits for – only the care you receive from a contracted network provider.^[3]

Most likely. There is typically an annual maximum benefit amount, which varies based on the plan you select. For example, a dental plan could have an annual limit on the number of procedures allowed per person, per calendar year.^[1]

There can also be a lifetime maximum amount for prosthodontics and major dental care services; be sure to check your policy for specific details, which vary depending on the plan you choose.

You may apply for standalone coverage at any time. Coverage often begins the next day after online enrollment, although some plans may require you to wait 6 months or more before you can take advantage of your benefits for certain services like fillings and root canals. You may enroll in a dental plan from the ACA Health Insurance Marketplace only during the annual open enrollment period (or a special enrollment period, if you qualify) when you enroll in your medical policy.^[1]