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Individual Dental Insurance

Friendly dentist working on patient's teeth.

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Dental insurance. We all want it but whether you are in San Antonio, Texas or Orlando, Florida, many of us do not have access to dental insurance. The stark reality is that in the American healthcare system, millions of us have zero access to affordable and comprehensive dental care, often having to resort to Groupon’s to get a decent price for a simple cleaning. In fact, the National Association of Dental Plans released statistics that show at the end of 2016, approximately 74 million Americans had no dental insurance coverage. This is the reality we hear from many people in San Antonio and beyond Texas respectively.

One of the biggest challenges for you, your family and the entire American public, is affordable dental care. This was a major health issue that was totally ignored by the Affordable Care Act (Obamacare) and is generally not covered by the Medicare system for millions upon millions of Americans.

Generally, there are only two ways you can get dental insurance:

1. Group Dental Insurance

2. Individual Dental Insurance

To obtain a reasonably priced and comprehensive dental insurance plan, you either have to work for the Government, a union, or a large/medium sized corporation that offers group dental insurance, which includes a set of rich and robust benefits to the employee. The catch here is that if the employee has dependents, they most likely will have to pay a much higher price than the employee, with the end result being that many of these dependents cannot afford the higher costs they would have to pay, in order to get this dental insurance coverage.

So, if you are not working for the Government, a union, a large/medium sized corporation, a dependent of someone that works for one of these entities, or on Medicare … then you have a big problem! The only option you have is to get an individual dental insurance plan.

At this point you may be saying to yourself, what’s the big deal? I’ll just go to a big health insurance company and buy a great plan at a low price for myself and/or my dependents. In a perfect world that might work, but since we don’t live in a perfect world, we have to deal with reality. So, what is the reality? The reality is that many of the individual dental insurance plans have very limited benefits, that essentially offer nothing more than preventative care such as cleanings and maybe some non-specific discounts. Worse, if we need more comprehensive services done such as a root canal, we may have to wait 6 months or more, to get coverage. This is often the case across the country, from Texas to California, and locally here in San Antonio as well.

Below, is a bit more information on dental insurance plans so you can quickly learn what you need to know to make an informed decision.

The basic format of how dental plans operate is as follows: 

1. Premium:

You pay a monthly premium to the insurance carrier to keep the plan active, regardless if you use it or not. Premiums will vary from plan to plan, and are also based on what type of plan you choose and the benefits included. Generally, the more included or covered, the higher the premium.

2. Deductible:

A deductible is what you have to pay out-of-pocket for services covered by your dental insurance plan, before the insurance company will pay. For example, a common one for dental insurance plans is $100 per calendar year.

3. Co-Pay’s and Co-Insurance’s:

After you meet your yearly deductible, your plan may have either a copay or co-insurance structure, depending on the plan. With a co-pay, it is a set amount you pay, for example, $50 for a cleaning. This is a set cost, so no need to calculate percentages or anything. With the latter, a co-insurance is the percentage you would pay of covered expenses, after meeting the deductible. So for example, let’s say your co-insurance for a simple tooth extraction is 30% and the cost for such a service in-network is $300, your cost would be $90. The dental insurance company would pay for the rest of your covered expenses up to your annual maximum.

4. Annual Maximum:

Dental insurance plans have what is called an annual maximum, which basically comes down to a set amount which is the most the insurance company will pay in a calendar year. A common number for this is $1,000 among the various dental insurance carriers.

5. HMO or PPO: 

Two of the main types of dental insurance coverage that you will be presented with are a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). With an HMO, you generally have the lower premiums, a restricted network of dentists and providers, and no coverage if you need a dentist outside of that network. The PPO on the other hand will have higher premiums, and a larger network of dentists and providers which you will have access to. If you are familiar with an HMO or PPO in the health insurance area, then these concepts should be pretty familiar to you, and work very similar. As a side note, we work with some really good dental insurance carrier’s that have a large PPO network here locally in San Antonio, Texas and elsewhere in the United States, that often are able to meet our client’s needs.

6. Waiting Periods:

When looking at individual dental insurance, you want to look at a few things very closely. One area is what is called a waiting period. Many times, a dental plan will have a stipulation that you have to wait a period of (1) year before services like tooth extractions, or root canals are covered. Some may be (6) months, and others like some of the plans we represent, have no waiting periods for certain services.

Keep in Mind:

If you also are looking for a dental insurance plan that covers implants, be aware that many of the plans out on the market today will not cover this. We made sure to contract with a carrier that did cover this important area, as many people over the years have inquired specifically about this segment of dental care.

One area of caution to be on the lookout for is dental discount plans. These are not the same as dental insurance, and operate more like price clubs. Basically, you would pay a fee, and get access to certain discounted rates at very select dentists. There is no payout from the discount plan company to your dental provider. We hear this a lot locally in San Antonio, Texas, where these dental discount plans send offers in the mail and it may seem like a good deal at first, but many do not realize that they are not insurance coverage they are buying.

At the Harrin Group here in San Antonio, Texas, we serve as a one-stop shop to find you dental insurance plans with the best benefits, at the lowest costs, thereby saving you many hours of research and stress. We also listen to our customers, so if you have a specific dentist or provider you currently see, we ensure they will accept the coverage you select, before presenting an option to you.

How Do I Enroll Online?

To sign up at your leisure 24/7, visit our “Enroll Online” page to select the product(s) of your choice, and easily enroll in minutes. And here is the nice part. Even if you self-enroll, we will be your local insurance agency if you ever have an issue or concern. No 1-800 # here, no waiting for the next representative (30 min later…), just a simple call, textemail, or live-chat away!

In the short humorous video below, you will see the character Homer Simpson from the famed show “The Simpsons”, be informed by his employer that he is losing his dental plan. Mr. Simpson soon is reminded by a familiar voice that his daughter needs braces soon and without dental insurance coverage, it could be very costly. In fact, the average cost of braces in 2020 ran from $5,000 to $6,000 nationwide, so whether you are in San Antonio, Texas or Seattle, Washington, be sure to compare what your local dentist charges if you do not have coverage. When looking at dental insurance plans, it is crucial to look at the outline of coverage, which will tell you exactly what all is covered, and if braces or other orthodontic care is at the top of your “must have” list, be sure it is listed as being covered in the plan. You do not want any surprises later on when you may need something done, and it is not covered.

Source: National Association of Dental Plans (NADP), Value Penguin, Mostly Simpsons/YouTube.

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