Posted April 6, 2015
If you’ve ever walked into a specialty ice cream store, you’re quickly overwhelmed by the number of options, including different flavors, toppings and cones. Americans love choices. But some are easier to make than others.
Take dental benefits, for example. There are many plan designs featuring various services available at different price points. It’s important to understand your dental health needs to make the best choice for dental coverage. Here are three important facts to know:
Many people purchase dental coverage through a stand-alone benefits plan offered by their employer. Stand-alone plans are offered separately from other plans, like medical. A Henry J. Kaiser Foundation 2014 Employer Health Benefits Survey discovered that 53 percent of companies providing health benefits offer or contribute to a stand-alone dental plan for their employees.
A stand-alone dental plan typically features:
- Complete family coverage, including adults and children, with the option to add orthodontia.
- An extensive dental provider network that typically is available to individuals and families across the country.
- Coverage choices that may be tailored to an employee’s specific needs.
- Plan premiums priced accurate to avoid drastic increases at renewal.
- Claims and customer service that support dental coverage.
The implementation of the Affordable Care Act has resulted in medical plans that include some dental benefits. These plans may offer coverage for children only or for the entire family, not just individual adult coverage. This combined plan may not offer the coverage expected. A few things to consider:
- Plan deductible may be $500 or higher.
- The annual preventive dental care benefits for dental exams and professional cleanings may be paid for children only. Adults will need to pay out of pocket for their own dental care.
- Common dental services, such as fillings and crowns, may not be covered until the deductible for the total plan is satisfied. Until it’s reached, costs for dental procedures will need to be paid out of pocket.
- Some plans may feature a limited number of participating dentists, so you may need to switch to a different dentist.
- Cosmetic orthodontia for kids may not be covered.
Pediatric dental coverage
Under the ACA, medical insurance carriers must offer pediatric dental coverage for dependents under age 19 in most states. Review these specifications:
- Medical insurance companies may advise parents and caregivers that they must purchase pediatric dental coverage as part of their medical plan. But that’s not the case.
- In many states, stand-alone dental insurance (providing complete family coverage) may be purchased separately from medical plans.
- Parents purchasing pediatric dental coverage will need their own dental plan to cover their oral health needs, including those of dependents age 19 and older.