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Health Care Reform:

Health Insurance & Affordable Care Act


Reviewed by Lisa Zamosky

WebMD Feature

What Kind of Dental Coverage Do You Need?

If you want to get dental insurance, you'll find a lot of plans to choose from. The options may seem overwhelming, but there are some easy ways to find the coverage you need.

Employer's Plan or the Insurance Marketplace?

Most Americans with dental insurance get their coverage from an employer, rather than buying insurance individually, according to Evelyn Ireland, executive director of the National Association of Dental Plans.

There are also options available in the insurance Marketplaces set up by the Affordable Care Act. Marketplaces are web sites in each state that let you shop for insurance plans. In the Marketplaces, you may be able to get dental coverage as part of a health plan. You may also be able to get dental coverage as a separate, stand-alone plan.

But keep in mind, the health reform law treats adults and children differently when it comes to dental coverage. Dental coverage for children is considered an essential health benefit. That means insurance plans in the Marketplace must offer it for kids. But health insurance plans don't have to offer dental care for adults.

What Types of Plans Are There?

HMO. The least expensive kind of dental coverage is through a type of plan called an HMO. In a dental HMO, you get all your dental care from dentists in your plan's network. If you go out of network, you will have to pay the full cost of the care you get.

PPO. Most employer-provided dental insurance comes through a plan known as a dental PPO. These plans usually have slightly higher monthly fees -- called premiums -- than an HMO.

Like an HMO, a PPO also has a preferred network of providers. But the network is usually bigger than the network in an HMO.

In a PPO, you still get some coverage if you go out-of-network. You will have to pay more of the total cost than if you used a dentist within the PPO's network. But unlike an HMO, you won't have to pay the whole cost.

Dental discount plan. This option is more like a Costco or Sam's Club of dentistry than traditional insurance. You pay a monthly fee -- usually around $10 to $15, Ireland says. In return, you get discounts on dental care.

Dental indemnity plans. These have higher premiums and co-pays than either HMOs or PPOs. A co-pay is a set fee that you pay each time you see a dentist.

The advantage of dental indemnity plans is that they allow you to choose any dentist you want.

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