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Health Care Reform:

Health Insurance & Affordable Care Act

What Kind of Dental Coverage Do You Need?

What Services Do Dental Plans Pay For?

Most dental plans divide their coverage into four general classes of service. Each covers different types of care:

Class I. Diagnostic and preventive care, like cleanings, checkups, and X-rays.

Class II. Basic restorative care, such as procedures like fillings and root canals.

Class III. Major restorative care, such as crowns and bridges.

Class IV. Orthodontia (braces). Not all plans have this coverage. The ones that do usually have a separate lifetime maximum, and may only cover braces up until a certain age, such as under 19.

"Dental coverage hasn't been designed to be really catastrophic coverage," Ireland says. "Instead, it has been designed more to encourage prevention and eliminate barriers to preventive care."

With a dental PPO, for example, coverage is typically "100/80/50." The plan pays 100% of preventive services, 80% of basic restorative care like fillings, and 50% of major restorative care. There is usually a $50 deductible. But Ireland says the deductible is often waived for preventive care and only kicks in when you need restorative services.

Dental HMOs, on the other hand, usually have specific copayments for services rather than a percentage. "HMOs generally say that when you go in for your dental exam, you pay $10. For a filling, you pay $20," Ireland says. "They don't state it as a percentage of some unknown number."

Dental HMOs also usually have no annual limit on coverage. There may be a coverage limit with a PPO.

Questions to Ask

Before you shop for dental coverage, ask yourself what's most important:

  1. Am I the type of person who doesn't like surprise expenses? If so, you might prefer a dental HMO, because it has more predictable costs.
  2. Do I want more choice in dentists? If you can accept slightly higher (and less predictable) costs in order to have a bigger pool of dentists to choose from, a dental PPO might be for you.
  3. Do I need unlimited freedom to choose a dentist? If, for example, you love your dentist and he's not in any HMO or PPO network available, the higher premiums and co-pays of a dental indemnity plan may be worth it.

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