The Top 7 Dental Insurance Companies in 2024
| Company |
Overall Score (1-5 Scale) |
Company Reputation and Reliability |
Plan Variety |
PPO Coverage Limitations |
PPO Costs |
Dental Insurance Alternatives |
| MetLife |
5.0 |
6.67 |
4 |
8 |
10 |
8.35 |
| Humana |
4.6 |
3.34 |
10 |
10 |
5 |
10 |
| Cigna |
4.1 |
10 |
0 |
4 |
8 |
5 |
| Guardian |
3.6 |
8.34 |
8 |
0 |
8 |
3.34 |
| Aetna |
2.6 |
5 |
2 |
2 |
4 |
1.67 |
| Renaissance |
2.4 |
1.67 |
6 |
2 |
2 |
6.68 |
| Surebridge |
2.1 |
0 |
6 |
5 |
0 |
0 |
Did you know?
Dental PPOs divide dental services into three categories: preventive, basic, and major. Other names, like I, II, and III, may be used to refer to the same categories.
- Preventative services usually include two yearly cleanings/exams plus some form of coverage for x-rays (may be labeled diagnostic).
- Basic services often include things like deep cleanings (for teeth that are in very bad shape), fillings, simple extractions, root canals (sometimes), and treatments for gum disease.
- Major services usually includes procedures like bridges, crowns, root canals (if not considered basic), and other high-cost services, including sometimes dentures and implants.
Many slight variations exist from company to company, so read plan documents carefully.
MetLife ranked first overall, scoring 5/5 stars. Its best metric is PPO Costs, with the company earning first place with 10/10 points thanks to the availability of some plans with very low premiums and deductibles. This company performed well in most other metrics, earning third place in Company Reputation and Reliability and second place in both PPO Limitations and Insurance Alternatives. However, MetLife ranked in fourth place in Plan Variety due largely to its low number of plans and lack of specialty options like loyalty plans and bundles.
How MetLife Scored
Company Reputation and Reliability: 6.67/10
With 6.67/10 points, MetLife ranks in 3rd place. It is the only company with an A+ rating from AM Best, making it second only to Guardian (A++). It is 3rd best in the Fortune 500 ratings with a ranking of 46. Founded in 1868, this company is the 4th oldest company we reviewed. Its rating on Google 3.4/5 stars was 4th best. With only 34 reviews Google posted, it’s somewhat difficult to know if the Google rating is representative of customer opinion.
MetLife scored 4/10, ranking in 5th place. This is one of three companies that offers two plan types, as opposed to the four plans that just offer PPOs. MetLife has both PPOs and HMOs. Its overall number of plans, 3, was tied with Cigna, Surebridge, and Renaissance for 2nd place. The highest number of plans available is 4 from Guardian and Humana. MetLife struggles to keep up when it comes to specialty plans, offering neither a loyalty PPO nor a bundled benefit plan.
MetLife scored 8/10 points in PPO Limitations for 2nd place in this metric. MetLife’s highest yearly maximum for first-year coverage is an impressive $2,000- a full $500 higher than its nearest competitor aside from Surebridge who also offers $2,000. However, MetLife does not have a loyalty plan. This company’s waiting periods are average- 6 months for basic services and 12 months for major services. You may be able to skip the waiting periods if you have had “comparable dental coverage” for 12 months or more and can prove that you are currently covered.
In 1st place with 10/10, MetLife performed best in this metric. Across MetLife plans, patients pay 0% for preventive care and 50% for major services if major services are covered. Coverage levels for basic services vary, but patients pay as little as 50% on the highest coverage plan. While $50 deductibles are by far the most common in the industry, MetLife has a deductible of just $25 on its PPO-High plan. PPO-Medium has a $50 deductible and PPO-Low has a $75 deductible. MetLife’s lowest sample quote was $17 per month, coming in as the lowest monthly quote of all companies we reviewed.
Insurance Alternatives: 8.35/10
Scoring 8.35/10 points, MetLife ranked 2nd on our list. The MetLife Discount Dental Program offers 5%-50% off dental procedures, depending on the item and office. The discount network of dentists is provided through Careington and may have 175,000+ participating locations, though MetLife itself does not advertise a number. Currently, the plan is not offered in Washington, Utah, or Vermont. Like plans from Renaissance and Humana, this plan includes discounts on non-dental items. In MetLife’s case, these perks include discounts on eye exams, frames, lenses, and LASIK procedures. MetLife’s discount program had the lowest cost on our list, with an annual premium of $211 for a single person. Customers can opt to pay monthly, quarterly, semiannually, or annually, and the cost is the same either way.
Quick Facts About MetLife
- Started: 1868
- Headquarters: New York City, NY
- Alternate Names and Related Companies: Individual plans from MetLife may be offered through “MetLife Takealong.” HMO plans from this company may be offered through MetLife Managed Care subsidiaries, but the company names vary by state. Dental Discount plans are offered in partnership with the third parties Careington International Corporation and VSP.
The MetLife Shopping Experience
MetLife is best known for its group (employment-based) benefits, so it keeps information on its individual plans on a separate website called the “MetLife Takealong” website. This brand is one of a few that does not ask about age when calculating premiums, so older seniors may have a slight price advantage. MetLife plans can also be found on some broker sites. This brand’s PPOs are generally available nationwide with very few exceptions, but its HMOs are available only in New York, California, Texas, and Florida.
Humana ranked highest overall with a score of 4.6/5 stars. This company was especially impressive in Plan Variety and PPO Limitations, ranking in 1st place for both. Humana also has a strong through not perfect score of 7/10 points in PPO costs, offering competitive premiums and coverage options. Humana ranked lower in other core metrics, and its lowest score was 2/10 on Insurance Alternatives due to limited options.
How Humana Scored
Company Reputation and Reliability: 3.34/10
Ranking in 5th place, Humana’s score was 3.34/10. Of the companies we reviewed, Humana had the best J.D. Power’s Dental Insurance Customer Satisfaction score with 793/1,000 (the highest company in that survey scored 810). Humana ranks at 41 on the Fortune 500 list and has 3.7/5 stars on Google reviews. Humana struggled the most with its AM Best score of A-, ranking the lowest on that submetric along with Surebridge. Its company history, although dating back to 1961, is also shorter than many competitors whose histories date back to the 1700 or 1800s.
Humana was 1st in Plan Variety with 10/10 points. Though no companies we reviewed offered all three main plan types (PPO, HMO, Indemnity), Humana was one of three companies that offered two types. Humana has both PPOs and HMOs. HMOs, in general, are rare now, and Humana’s are only offered in California, Florida, Maryland, Pennsylvania, Texas, Utah, New York, Nevada, and Guam. Among its four PPO options, Humana has a loyalty plan (Loyalty Plus PPO) and a plan that offers extra health discount benefits to veterans (Bright Plus for Veterans). In some cases, Humana dental plans can also be bundled at a low cost with vision or hearing benefits. Bundled plans may be easiest to find on broker sites.
Humana ranked 1st with 10/10 points thanks to its great waiting period policies. Humana’s Bright Plus PPO has no waiting period for basic services, and its Loyalty Plus PPO has no waiting periods even for major dental work. Humana’s highest yearly maximum for the first year of coverage was $1,500. Its highest yearly maximum reachable in a loyalty plan was $1,000. For comparison, Surebridge’s loyalty maximum was $2,000, Renaissance’s $1,000, and all other companies lacked plans with increasing maximums.
Humana scored 5/10 points, ranking in 4th place. It has premiums starting at $19 per month, just $2 more than the lowest premium of $17 from MetLife. Humana’s coinsurance levels were typical on most plans, with customers paying 0% for preventive services, 30% for basic services, and 50% for major services on its highest coverage plans. Most of its deductibles are $50 per person each year, but its loyalty plan has an unusual lifetime $150 deductible instead. Keeping that plan for three or more years makes the high deductible more palatable.
Insurance Alternatives: 10/10
Humana scored 10/10 points in this category, ranking in 1st place ahead of all of its competitors. Humana’s Dental Discount Plus plan offers discounts averaging from 20%-40% with a network of over 335,000 dental locations. The plan includes discounts on some non-dental services, too. Unfortunately, the plan’s pricing is listed in a confusing way. Online, it seems the lowest annual cost for Humana’s dental coverage alternatives comes to $216 per year. Those interested in Humana’s discount plan should note that payments can only be made monthly and that it is currently not offered in 7 states.
Quick Facts About Humana
- Started: 1961
- Headquarters: Louisville, KY
- Alternate Names and Related Companies: Humana Inc. has such a large number of subsidiaries that they are referred to collectively as “Humana Entities.” Names tend to vary by state. HumanaDental Insurance Company is a name you’re likely to see in reference to discount plans. A complete list of Humana Entities can be found on Humana’s own site.
The Humana Shopping Experience
You can shop for Humana plans through the Humana website itself or through some online insurance brokers. Quote tools on websites will generally ask you for your age and the state you live in, though some broker sites may ask for additional information. The information given on the plans through quote tools usually includes fine print on service limits and exclusions, which seniors should take into account when selecting a plan.
Seniors shopping Humana should be aware that this company’s plan availability varies greatly by state – more than is average for other companies. The majority of the states do have a dental discount plan, but 7 states do not, and the website simply lists the 43 states that do. Many states only have one or two plan options, though Humana’s full dental insurance product catalog includes 3 insurance options plus a dental discount plan.
Scoring 4.1/5 overall, Cigna ranked in 3rd place for its dental plans. As a very well-established company in the industry, Cigna achieved 1st place for Company Reputation and Reliability. This company had a reasonably strong showing in PPO Costs and Insurance Alternatives, but it faltered in Plan Variety, where it came in last.
How Cigna Scored
Company Reputation and Reliability: 10/10
Cigna ranked in first place for Reputation and Reliability, scoring 10/10 points. Tracing its company roots to 1792, Cigna is the oldest company on our list. It’s also the most financially successful company, ranking number 13 on the Fortune 500 list. AM Best rates Cigna an A for financial stability, a score that puts the company in 3rd place for that submetric along with Aetna and Renaissance. JD Powers rates Cigna’s dental plans 787/1000, the 3rd best score among competitors that we reviewed. Cigna had 132 ratings on Google with an overall rating of 4/5 stars- the best on our list.
Cigna’s plan variety is quite limited, so this company ranked in last place with 0/10 points. Cigna offers just PPO dental and has 3 plan options total. Cigna has neither bundling options nor loyalty plans. Its plans still offer good coverage choices for many people, but it just doesn’t present the same range available elsewhere.
With 4/10 points, Cigna ranked in 4th place for PPO Limitations. Its annual maximum is a generous $1,500, the 2nd highest of the companies we reviewed. Unfortunately, none of Cigna’s plans have the increasing yearly maximums that some people like in loyalty plans. Waiting periods in Cigna plans are standard- 6 months for basic services and 12 months for major services. Cigna does offer a waiver on waiting periods in some circumstances. You’ll need to have been covered for a full year by another plan if you want to qualify for the waiver, and other restrictions may apply.
Cigna ranked tied in 2nd place with 8/10 points for PPO Costs. This company’s main pricing issue is that it does not offer plans through broker sites, and its own quote tool makes it somewhat difficult to get a personalized quote. Cigna’s starting costs are prominently listed as being $21. The way Cigna advertises its prices was something we found unnecessarily confusing. Cigna’s deductibles are a reasonable $50, and its coverage rates are comparable to other companies. Patients pay 0% for preventive care across the board and can pay as low as 20% for basic and 50% for major services, depending on the plan.
Insurance Alternatives: 5/10
Cigna scored 5/10 points for Insurance Alternatives, ranking in 4th place. Its “Dental Savings Program” excludes an unusually large number of states, including the following: Alaska, California, Montana, North Dakota, Oklahoma, Rhode Island, South Dakota, Utah, Vermont, and Washington. In covered states, seniors can choose from three different discount options. There’s a basic option that includes just dental discounts, or they can pay more for the “family” version that has expanded benefits on everything from prescriptions to recreational activities. Cigna offers three different discount options. The least expensive plan is available for $252 per year, in line with the costs of Guardian’s discount plans.
Quick Facts About Cigna
- Started: 1792
- Headquarters: Bloomfield, CT
- Alternate Names and Related Companies: Cigna’s full name is Cigna Health and Life Insurance Company. Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. are all subsidiaries.
The Cigna Shopping Experience
Cigna is one of the more difficult companies to shop online. Its quote tool makes it appear as if those who are interested in learning more about costs need to provide contact information and wait to be contacted by an agent. This is actually not true – seniors can leave contact fields blank and still see a personalized quote. Be aware that Cigna quotes are not available on broker websites. Despite the difficulties with getting quotes from Cigna, customers may appreciate how much educational material Cigna provides online about dental insurance.
Ranking in 4th place overall, Guardian scored 3.6/5 points. This company’s best metric was Company Reputation and Reliability, in which it stands out as the only company with a perfect financial stability rating from AM Best. Guardian is also notable for its ranking of 2nd place in Plan Variety as 1 of only 3 companies we reviewed that offers a low-cost HMO option. This company ranked last for PPO Limitations, but 2nd place for PPO Costs.
How Guardian Scored
Company Reputation and Reliability: 8.34/10
With 8.34/10 points, Guardian has the best Company Reputation and Reliability. It’s remarkable as the only reviewed company rated A++ by AM Best. Other companies we reviewed had ratings of A- to A+. Founded in 1860, Guardian is the 3rd oldest company we reviewed and has 160+ years of experience in insurance. While it doesn’t have the largest revenue among competitors, Guardian does rank as number 227 on the Fortune 500 list. This company has a respectable rating of 746/1,000 from the JD Powers survey, and it has a great Google profile rating of 3.8/5 stars (based on 35 posted ratings).
Guardian scored 8/10 points, ranking in 2nd place. Offering both PPOs and HMOs, Guardian offers slightly more consumer choice than the four companies that only sell PPOs. However, Guardian’s HMO coverage is limited to California, Texas, New Jersey, New York, Ohio, Florida, Colorado, Illinois, Indiana, Michigan, and Missouri. Between PPOs and the HMO, Guardian offers 4 plans, of which one is a loyalty plan. Unfortunately, Guardian does not offer a clear bundling option for combining dental with vision, hearing, or other supplemental benefits. Customers may wish to ask a sales agent about the possibility of getting vision coverage since Guardian does sell some items separately.
With 0/10 points, Guardian ranks last in this metric. Its low score is due mainly to no waiver option for waiting periods. Guardian’s highest yearly maximum benefit is $1,500, on par with Cigna. Its loyalty maximum is low at $1,500, compared to a high of $3,000 from Renaissance. Guardian has waiting periods of 6 months for basic services and 12 months for major services.
Guardian comes in third, tied with Cigna, scoring 8/10 points. This company’s lowest sample quote was identical to Cigna’s at $21, closely compared to similar plans that start around $19 elsewhere. Patients face standard costs for preventive (owing 0%), basic (owing 20%), and major services (paying as low as 50%). At most other companies, the patients can pay as low as 20% for the same service category. Guardian’s deductible is $50.
Insurance Alternatives: 3.34/10
Only better than Surebridge, Guardian earned 3.34/10 points and ranked in 5th place in this category. Guardian offers 4 alternative dental discounts, costing $252 annually. Only a monthly payment option is available.
Quick Facts About Guardian
- Started: 1860
- Headquarters: New York City, NY
- Alternate Names and Related Companies: Guardian’s full name is The Guardian Life Insurance Company of New York, New York. Guardian Direct is the subsidiary that individual plans may be offered or underwritten by.
The Guardian Shopping Experience
Guardian has recently changed its website, and those trying to shop online may occasionally encounter glitches associated with the changes. Overall, the way this brand’s website works can be confusing. The Guardian Direct (individual insurance) quote tool asks for contact information, but it is possible to get a quote from the tool without providing that information if doing so makes you uncomfortable. For those having trouble with the website, calling Guardian is always a good option to get help, and quotes are also readily available at some broker sites. Note that this company’s PPOs are available in about 45 states, and its HMOs are available in just 11 states.
In 5th place overall, Aetna scored 3.4/5 stars. As the best overall option for Insurance Alternatives, Aetna suits those seeking a low-cost dental discount plan. This brand also has a strong presence in both PPO Costs and Reputation and Reliability, earning 4th place in both of those metrics. Aetna’s overall score was reduced due to limited plan variety and low maximum benefit amounts.
How Aetna Scored
Company Reputation and Reliability: 5/10
Landing in 4th place, Aetna scored 5/10 points. With a company history dating back to 1853, Aetna has the 2nd longest amount of experience in the industry. Its JD Powers’ score is also 2nd best at 791/1,000, topped only by Humana among reviewed companies. Aetna’s rating of A in financial stability from AM Best is lackluster when compared to Guardian’s A++. Aetna did not rank in the Fortune 500 list, and its 2.6/5 stars on Google reviews ranked in 5th out of 7 places in that submetric. Aetna’s Google profile score is based on 67 reviews.
With a Plan Variety score of 2/10, Aetna keeps its plan selection simple, ranking in 6th place. This company’s only dental insurance style is PPOs, and it only offers 3 plans (Preventive, Core, and Preferred). While many competitors offer loyalty plans with benefits that increase over time, Aetna does not. It does, however, offer some insurance bundling options. Adding vision benefits to your Aetna dental plan is very easy.
Tied with Renaissance in 6th place for PPO Limits, Aetna scored 2/10 points. Aetna’s waiting periods are standard- 6 months for basic services and 12 months for major services. Waiting periods can be waived, too, as long as those applying to the plan had dental insurance within the 90 days prior to applying for an Aetna plan. Aetna struggles to compete with other companies with its annual maximums. The highest maximum this company offers is $1,250, which is 3rd best and lower than the $1,500 or even $2,000 maximums of some competitors. Aetna also does not offer any maximums that increase with time (loyalty maximums).
Aetna has mid-range PPO costs, sitting at 5th place in this metric with 4/10 points. Premiums from this brand start at $22, and deductibles are the industry standard of $50. Likewise, the best coinsurance levels from this company are in line with what’s most common among competitors. On Aetna plans, patients pay 0% for preventive services, as low as 20% for basic services, and 50% for major services. Though not exceptional in any price submetric, Aetna’s overall price structure is reasonable and predictable.
Insurance Alternatives: 1.67/10
In Insurance Alternatives, Aetna is the lowest of our reviewed companies with 1.67/10. Aetna has two dental discount plans, called Vital Savings and Dental Plus RX. These plans are available for purchase on a monthly basis. In a year, the total cost is $354 and is on the high side compared to its competitors. The main dental discount plan is available everywhere but in Montana and Vermont, and the prescription drug discount add-on may be slightly more limited. Seniors should note that Aetna advertises its discount levels as being between 15%-50% for many procedures.
Quick Facts About Aetna
- Started: 1853
- Headquarters: Hartford, CT
- Alternate Names and Related Companies: Other names for Aetna include Aetna Life Insurance Company and Aetna Dental Direct. Certain parts of Aetna’s dental plans may operate with assistance from the third-party companies First American Administrators, Inc. and/or EyeMed Vision Care LLC. Customers should note that CVS Pharmacy acquired Aetna in 2018.
The Aetna Shopping Experience
Aetna offers its plans on its own website, and its quote tool is a bit challenging to use. It will ask for your full name and several other personal details. However, you don’t actually need to provide contact information in order to see prices, so you don’t need to worry about being cold-called. Aetna plans have good national availability, though a few states may be excluded. Seniors should be aware that Aetna quotes are often not available through popular insurance broker sites- shopping on Aetna’s own website or contacting a licensed agent is your best shopping option.
Renaissance scored 2.4/5 stars overall, ranking in 6th place. This brand’s strengths showed up well in two different metrics: Plan Variety (3rd best) and Insurance Alternatives (2nd best). With high starting costs, complex coverage rules, and some mediocre customer ratings, Renaissance ranked 6th in PPO Costs and Company Reputation and Reliability.
How Renaissance Scored
Company Reputation and Reliability: 1.67/10
Renaissance scored 1.67/10, ranking in 6th place for this metric. While its company history stretches back 63+ years, it just doesn’t have as much experience as companies that were founded in the 1700s and 1800s. Its financial stability rating of A from AM Best and its customer rating of 2.2 on its Google profile was lackluster since some companies scored A++ and 4+/5 Google stars. Renaissance was not included in the JD Powers’ survey, nor does it have a high enough revenue to rank on the Fortune 500 list.
Renaissance scored 6/10 points and ranked in 3rd place for Plan Variety, tied with Surebridge. While Renaissance only offers one plan type, PPOs, it has 3 different PPOs to choose from. Some of the plans include bundled vision benefits and have coverage levels that increase over time (loyalty benefits). These special plans are part of the “Max” PPO product series.
With 2/10 points, Renaissance ranked in 6th place in front of Guardian in PPO limitations. Renaissance’s most notable weakness in this metric is that it does not waive waiting periods for any reason. Plans in the “Max” series of bundled plans don’t have waiting periods, so in some cases, the lack of waiver is a moot point. However, the company’s lower coverage plans have 6-month waiting periods for basic coverage and 12-month waiting periods for major services. Renaissance’s yearly maximums are a mixed bag: loyalty plan maximums can reach $3,000, the best of all the companies, but non-loyalty plans are capped at a low $1,2000.
Renaissance ranked poorly in the PPO costs category, scoring 2/10 points. One factor that reduced Renaissance’s score is that its overall cost-sharing structure was less clear than that of other companies. Patients may need to pay as much as 50% for preventive services on some plans (compared to 0% everywhere else). Basic services can cost patients between 20%-50% (percentage can vary by procedure) and 50% for major services. This company’s absolute lowest monthly premium is $31, or $14+ more than the lowest premium from MetLife. Deductibles for Renaissance are a reasonable $50.
Insurance Alternatives: 6.68/10
Renaissance’s dental discount plan is a competitive option that ranks in second place with 6.68/10 points. This plan is referred to as the Healthy Savings Card and is administered by the third-party company Careington. Dental discounts range from 20%-50% for most services. Costing $372 per year, this plan is one of the more expensive discount options. Yearly payments appear to be the only option for purchasing this plan. Although Renaissance only has one option for this kind of plan, the plan conveniently includes other benefits for vision, hearing, and a variety of other health discounts.
Quick Facts About Renaissance
- Started: 1957
- Headquarters: Indianapolis, IN
- Alternate Names and Related Companies: Some plans offered by Renaissance are actually offered by an independent division called Renaissance Life & Health Insurance Company of New York. The Healthy Savings Card is administered by the third-party companies Careington International Corporation and VSP (a vision care network).
The Renaissance Shopping Experience
You can shop Renaissance plans on the Renaissance website or through some broker sites. The Renaissance website offers the most complete range of plan options, but it can be a bit difficult to find what you’re looking for. The company’s series of basic plans are listed on a different part of the website than its bundled/loyalty plans are. Furthermore, to shop for its Healthy Savings Card you will need to call the number provided on the website. Applying directly online is not currently an option. Renaissance does not list any major location exclusions for its insurance, all though not all states will have the same number of available plans.
Overall, Surebridge scored 2.1/5 stars for 7th (and last) place. Surebridges scores were neither especially high nor especially low for Plan Variety and PPO Limitations. Unfortunately, in both Company Reputation and Reliability and Insurance Alternatives, Surebridge ranked in last place, falling behind the majority of competitors due to its newness on the market and its lack of alternative options.
How Surebridge Scored
Company Reputation and Reliability: 0/10
Surebridge ranked in 7th place with 0/10 points for reputation and reliability. In this case, a score of 0 means that, for each of the 5 relevant questions we asked about Reputation and Reliability, Surebridge’s answers were the least impressive. Founded in 2011, Surebridge has an AM Best rating of A- and a Google review rating of 1.9/5 stars. It was not rated in the JD Powers survey or ranked in the Fortune 500 list. The relative newness and smallness of this company make it difficult to evaluate its reliability. Its Google business profile’s low rating is based on 116 reviews.
Tied for 3rd place and scoring 6/10 points, Surebridge has limited variety but still offers some unusual choices. Offering only PPOs, Surebridge has no indemnity or HMO options. With 3 PPOs to choose from, Surebridge has the fewest plans overall, along with Aetna, Cigna, And Renaissance. The highest number of plans offered by any company is 4. Despite having few choices, Surebridge does offer a special loyalty plan that includes bundled hearing and vision benefits. This plan, the DVH PPO, is a great choice for those who want a flexible, high coverage option. Note that this loyalty plan doesn’t have increasing maximums, unlike most loyalty plans, but it does have increasing coverage percentages for a variety of dental services.
Ranking in 3rd place with 5/10 points, Surebridge offers high annual maximums, typical waiting period lengths, and the option of a waiting period waiver for those who qualify. Its regular PPOs have between $1,200-$1,500 yearly maximums, and its bundled loyalty plan has an annual maximum option of up to $2,000. Customers should note that the loyalty maximum is a combined maximum that applies to the bundled vision and hearing benefits of that unique plan as well. Surebridge has no waiting period for basic dental services and a 9-month waiting period for major services. The 9-month period cannot be waived.
Surebridge ranked 7th, scoring 0/10 points in the cost category. Its PPO Basic plan, a low-coverage option, has a monthly premium of around $43, higher than any other competitor we reviewed. Surebridge has a $50 deductible on most plans, though on its DVH plan its deductible is $100 for combined dental, vision, and hearing benefits. On its fullest coverage plans, patients pay 20% for basic services and 50% for major services. Surebridge also charges 50% coinsurance on preventive care, matching Renaissance as the only two companies to do so.
Insurance Alternatives: 0/10
Surebridge offers three discount plans as alternatives to traditional insurance. The lowest annual cost for the alternatives, however, is $516. This is much higher than every other alternative plan we reviewed. Monthly payment plans are the only option for payment.
Quick Facts About Surebridge
- Started: 2011
- Headquarters: North Richland Hills, TX
- Alternate Names and Related Companies: The Chesapeake Life Insurance Company underwrites Surebridge’s dental plans, and HealthMarkets is the parent company.
The Surebridge Shopping Experience
Surebridge plans are readily available on both broker sites and through the Surebridge website, and plans are offered across the nation. The Surebridge website has a confusing format, so in some cases, seniors may find broker websites easier to navigate than the Surebridge site. Surebridge appears to affix the label “senior” to some of its PPO options without any real meaning in terms of plan/cost differences.
Financial Assistance for Dental Insurance for Seniors on a Budget
Dental insurance may seem too expensive, but it’s more important than you may realize. Oral health can have a major impact on the rest of the body, and financial assistance to access dental care can be helpful in maintaining overall health.
Unfortunately, Medicare typically does not cover dental care, and less than half of states’ Medicaid programs offer any dental insurance coverage for older adults. But for those struggling to afford the costs of dental care, there are some alternatives to traditional dental insurance. Government programs, charitable organizations, and even credit card companies offer a way to cover some or all of the cost of dental procedures.
Below are a few dental resources for seniors on a budget.
Medicare Coverage of Dental Insurance
Medicare does not typically cover dental procedures, except in extreme circumstances. When a dental emergency occurs and lands a patient in the hospital, Medicare will likely cover part or all of the procedures to repair the damage. However, regular checkups, fillings, root canals, crowns, and other common dental procedures are not covered.
While Medicare Part A will rarely cover dental work, Medicare Part C, also known as Medicare Advantage, can include dental coverage. These plans are managed by private insurers who can choose exactly what they will and won’t cover. Searching for a Medicare Advantage Plan that includes dental coverage can be a good way to help bring down the out-of-pocket expenses of senior dental care.
To get started, visit the Find A Medicare Plan tool on the Medicare website. You can create an account or continue without logging in. On the next page, choose “Medicare Advantage Plan” and enter your zip code. The system may request that you select your county, too. Finally, the tool will ask if you receive any other assistance for your medical bills. Select any programs you belong to, and click ‘continue.’
On the next page, the tool will ask if you want to see specific drug costs. If you have prescriptions, it’s a good idea to select ‘yes’ and add them to the list on the next page. If not, you can select ‘no’ and move on.
After moving to the final page, you’ll see a listing of Medicare Advantage plans. You can add a variety of filters to the search results by clicking the various options next to the words ‘filter by.’ If you filter by ‘plan benefits,’ you can then select ‘dental coverage.’ Now, you’ll be presented with a list of Medicare Part C (Medicare Advantage) plans that are available in your area and also provide dental coverage.
Medicaid Coverage of Dental Insurance
While Medicaid’s Children’s Health Insurance Program (CHIP) is required to offer dental care to kids, Medicaid is not required to offer any dental coverage to adults. Less than half the states in the US provide comprehensive dental coverage to adults on Medicaid. In these states, the coverage tends to be reserved for those with the greatest financial need.
According to the Center for Healthcare Strategies, Medicaid covers adult dental services on four different levels: no coverage, emergency coverage, limited coverage, and extensive coverage. Each state offers different services and different levels of cost. Below is a table detailing each state’s Medicaid dental coverage:
|
State
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Medicaid Coverage of Dental Care
|
State Medicaid Website
|
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Alabama
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None – No dental coverage available through Medicaid
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https://medicaid.alabama.gov/content/4.0_Programs/4.2_Medical_Services/4.2.2_Dental.aspx
|
|
Alaska
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Emergency – Up to $1,150 per year for preventive dental care, and enhanced services offer preventive and restorative care.
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https://dhss.alaska.gov/dph/wcfh/Pages/oralhealth/faq.aspx
|
|
Arizona
|
Emergency – ALTCS members receive up to $1,000 in preventive care and up to $1,000 in emergency care.
|
https://www.azahcccs.gov/Resources/Downloads/DFMSTraining/2018/DentalUpdates.pdf
|
|
Arkansas
|
Limited – Up to $500 per year for most dental care, as well as limited coverage for services deemed necessary by a dentist.
|
https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/dental/
|
|
California
|
Extensive – Up to $1,800 per year, plus additional coverage if dental work is seen as medically necessary.
|
https://www.dhcs.ca.gov/services/Pages/MediCalDental.aspx
|
|
Colorado
|
Extensive – Up to $1,500 per year.
|
https://hcpf.colorado.gov/dental-benefits
|
|
Connecticut
|
Extensive – Up to $1,000 per year.
|
https://portal.ct.gov/HUSKY/The-Connecticut-Dental-Health-Partnership
|
|
Delaware
|
None – No dental coverage available through Medicaid
|
https://www.dhss.delaware.gov/dhss//dmma/adult_dental_benefits.html
|
|
District of Columbia
|
Extensive – Coverage for children and adults, including 2 annual cleanings and restorative fillings.
|
https://dc.gov/service/medicaid
|
|
Florida
|
Emergency – Only emergency dental situations are eligible for coverage.
|
https://ahca.myflorida.com/medicaid/Policy_and_Quality/Quality/clinical_quality_initiatives/oral_health/index.shtml
|
|
Georgia
|
Emergency – Only emergency room visits and life-threatening situations are eligible for dental coverage.
|
https://dhs.georgia.gov/medicaid
|
|
Hawaii
|
Emergency – Adults can receive emergency care to control dental pain or infection.
|
https://medquest.hawaii.gov/en/members-applicants/quest-integration-coverage/covered-services.html
|
|
Idaho
|
Extensive – Preventive, diagnostic, and therapeutic dental coverage for all adults.
|
https://healthandwelfare.idaho.gov/providers/managed-care-providers/dental
|
|
Illinois
|
Extensive – A wide variety of services are covered for adults. See the link for a detailed fee schedule.
|
https://www2.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/Dental.aspx
|
|
Indiana
|
Limited – HIP Basic doesn’t cover dental services, but HIP Plus offers dental and other services for a low, predictable monthly cost.
|
https://www.in.gov/medicaid/
|
|
Iowa
|
Extensive – Up to $1,000 per year of dental coverage.
|
https://dhs.iowa.gov/ime/members/medicaid-a-to-z
|
|
Kansas
|
Limited – Dental care is available for children, while limited preventive care is available for adults.
|
https://www.kdhe.ks.gov/183/KanCare-Medicaid
|
|
Kentucky
|
Limited – Adult coverage includes limited oral exams, emergencies, x-rays, extractions, and fillings.
|
https://chfs.ky.gov/agencies/dms/dpo/bpb/Pages/dental.aspx
|
|
Louisiana
|
Limited – Adult coverage is limited but includes exams, x-rays, and dentures.
|
https://ldh.la.gov/page/2067
|
|
Maine
|
Emergency – Coverage is limited to emergency surgery, extractions, pain relief, infection care, and services to avoid tooth loss.
|
https://www.maine.gov/dhhs/oms/mainecare-options/adults
|
|
Maryland
|
None – No dental coverage available through Medicaid
|
https://health.maryland.gov/mmcp/Pages/maryland-healthy-smiles-dental-program.aspx
|
|
Massachusetts
|
Extensive – Adults enrolled in MassHealth are eligible for dental coverage.
|
https://www.mass.gov/info-details/learn-about-masshealth-dental-benefits
|
|
Michigan
|
Limited – Coverage includes limited checkups, cleanings, x-rays, fillings, extractions, and dentures.
|
https://www.michigan.gov/mdhhs/assistance-programs/healthcare/help/type/free-or-low-cost-care-from-a-dentist
|
|
Minnesota
|
Limited – Only services deemed medically necessary and cost-effective. Evaluations, preventive care, and restorative care can be covered. Prior approval may be needed.
|
https://mn.gov/dhs/medicaid-matters/oral-health/
|
|
Mississippi
|
Limited – General dentistry, oral surgery, and orthodontia are covered.
|
https://medicaid.ms.gov/medicaid-coverage/covered-services/
|
|
Missouri
|
Limited – Services are only available for those in a category of assistance for pregnant women or the blind.
|
https://health.mo.gov/living/families/oralhealth/low-cost.php
|
|
Montana
|
Extensive – Up to $1,125 of annual dental coverage.
|
https://dphhs.mt.gov/MontanaHealthcarePrograms/Dental
|
|
Nebraska
|
Limited – Up to $750 of annual dental coverage.
|
https://dhhs.ne.gov/Pages/Medicaid-Dental-Benefits-Manager.aspx
|
|
Nevada
|
Emergency – Dental exams and extractions in an emergency are covered, and sometimes dentures when necessary.
|
https://dhcfp.nv.gov/Pgms/CPT/Dental/
|
|
New Hampshire
|
Emergency – Coverage for severe dental trauma. Plans are being implemented for preventive care for adults.
|
https://www.dhhs.nh.gov/programs-services/medicaid
|
|
New Jersey
|
Extensive – Coverage includes 2 annual checkups, diagnostic services, restorative services, and oral surgery, among other benefits.
|
https://www.nj.gov/humanservices/dmahs/boards/maac/MAAC_Meeting_Presentations_4_13_17.pdf
|
|
New Mexico
|
Extensive – Dental coverage varies by dental provider.
|
https://www.hsd.state.nm.us/lookingforinformation/dental-care-information/
|
|
New York
|
Extensive – No spending limits for dental coverage. Care includes preventive, periodontal, dentures, and oral surgery.
|
https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf
|
|
North Carolina
|
Extensive – No spending limits for dental coverage. Care includes preventive, periodontal, dentures, and oral surgery.
|
https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf
|
|
North Dakota
|
Extensive – Coverage includes exams, x-rays, filling, surgery, cleanings, root canals, and other dental services.
|
https://www.nd.gov/dhs/services/medicalserv/medicaid/covered.html
|
|
Ohio
|
Extensive – Coverage includes, cleanings, dentures, fillings, extractions, crowns, oral surgery, and root canals
|
https://medicaid.ohio.gov/families-and-individuals/srvcs/dental
|
|
Oklahoma
|
Emergency – Extractions in emergency situations are covered.
|
https://oklahoma.gov/ohca/individuals/soonercare-dental.html
|
|
Oregon
|
Extensive – No details available.
|
https://www.oregon.gov/oha/HSD/OHP/Pages/Policy-Dental.aspx
|
|
Pennsylvania
|
Limited – Emergencies and oral surgeries are covered, along with other services in specific circumstances.
|
https://www.dhs.pa.gov/Services/Assistance/Pages/Dental-Services.aspx
|
|
Rhode Island
|
Extensive – Coverage includes 2 annual checkups, x-rays, root canals, restorative, and periodontal services, among others.
|
https://eohhs.ri.gov/sites/g/files/xkgbur226/files/Portals/0/Uploads/Documents/Dental_Benefits_for_Adults_-2007.pdf
|
|
South Carolina
|
Limited – Up to $750 annually for 1 annual cleaning, oral exams, x-rays, extractions, and fillings.
|
https://www.scdhhs.gov/press-release/healthy-connections-now-provides-adult-dental-benefits
|
|
South Dakota
|
Limited – Up to $1,000 annually for 2 annual exams, 2 annual cleanings, fillings, x-rays, extractions, and more.
|
https://dss.sd.gov/medicaid/recipients/dental.aspx
|
|
Tennessee
|
None – No dental coverage available through Medicaid
|
https://www.tn.gov/tenncare/members-applicants/dental-services.html
|
|
Texas
|
Emergency – Only dental care needed in an emergency is covered by Medicaid.
|
https://www.hhs.texas.gov/services/health/medicaid-chip/about-medicaid-chip/medicaid-medical-dental-policies
|
|
Utah
|
Emergency – Coverage is limited to emergency situations for non-pregnant adults.
|
https://health.utah.gov/umb/benefits/medicaid/dental.php
|
|
Vermont
|
Limited – Up to $510.00 per year for non-cosmetic procedures.
|
https://www.healthvermont.gov/wellness/oral-health/dental-care-and-insurance
|
|
Virginia
|
Emergency – Adult dental coverage is limited to emergencies only.
|
https://www.dmas.virginia.gov/#/dentalservices
|
|
Washington
|
Extensive – Coverage includes exams, cleanings, x-rays, fillings, extractions, oral surgery, and more.
|
https://www.hca.wa.gov/health-care-services-supports/apple-health-medicaid-coverage/dental-services#dental-services-for-adults
|
|
West Virginia
|
Emergency – Oral surgery is covered in emergency situations. Orthodontic services require prior authorization.
|
https://dhhr.wv.gov/bms/Provider/LTC/Documents/Chapter%20505%20Dental,%20Orthodontics,%20and%20Oral%20Health%20Services.pdf
|
|
Wisconsin
|
Extensive – Coverage includes annual exams and cleanings, but does not cover orthodontia.
|
https://www.dhs.wisconsin.gov/guide/freedental.htm
|
|
Wyoming
|
Limited – Emergency and preventive care only. Restorative dental coverage is not available.
|
https://health.wyo.gov/wp-content/uploads/2018/02/Dental-Services.pdf
|
* Be sure to check your state’s Medicaid website for the latest updates. Detailed information on state-specific Medicaid dental coverage can be found here.
Veterans Resources for Dental Insurance
Veterans Affairs offers a wide array of dental services to veterans of the Armed Forces. In 2021, the organization provided dental care to over 500,000 veterans.
Qualifying for dental care through the VA can be complicated, however. Care is provided to certain groups based on a variety of factors, including:
- Military branch
- Length of services
- Former POW status
- Service-related disabilities
- Specific wars of enlistment
- Inpatient status (hospital, nursing home, etc)
Below is a table detailing dental coverage for specific classes of military veterans.
|
Class
|
Situation
|
Dental Coverage
|
|
I
|
Experiencing service-related dental disability and receiving monthly compensation
|
All needed dental care is covered
|
|
II
|
Served 90+ days in the Persian Gulf War
|
One-time dental care available if you didn’t receive a dishonorable discharge, applied for coverage within 180 days of discharge, and DD214 doesn’t show a complete dental exam and all needed treatment before discharge
|
|
IIA
|
Experiencing a service-related, non-compensable dental issue, or a combat wound/service trauma disability
|
All needed dental care required to ensure you keep a working set of teeth
|
|
IIB
|
Member of Homeless Veterans Dental Program
|
One-time dental care a VA provider deems necessary for pain relief, helping you get a job, or treating gingival or periodontal conditions
|
|
IIC
|
Former POW
|
All needed dental care is covered
|
|
III
|
Experiencing a dental condition brought on by service-related health issues
|
All dental care to treat oral conditions that the VA provider determines are making the service-related health condition worse
|
|
IV
|
Unemployable and receiving 100% disability benefit due to service
|
All needed dental care is covered, as long as the 100% disability rating is permanent
|
|
V
|
Active in Ch 31 Veterans Readiness & Employment Program
|
All dental care a VA provider deems necessary for you to be in the employment program, reach the goals of the program, protect you from having to stop the program, help you get back to the program faster if you’ve stopped, help you get and adjust to a job, or make you fully independent in your living
|
|
VI
|
Receiving VA care or about to enter inpatient care
|
All dental care needed to treat the issue that a VA provider finds is making your inpatient condition harder to treat
|
|
Inpatient
|
Receiving inpatient care
|
All dental care needed that a VA provider and primary care physician deem necessary to help with your current inpatient condition
|
Homeless veterans also have financial options for dental care. The Homeless Veterans Dental Program is a separate dental program that specifically assists those dealing with homelessness or who are in the VA homelessness rehabilitation program.
Additional Financial Assistance Resources for Dental Insurance
In addition to the above resources for dental coverage and discounts, there are other paths to assistance for those who can’t afford dental care.
As mentioned earlier in this article, most dental insurance companies offer a non-insurance discount plan. Typically priced at $70 – $150 per year, these plans offer access to a network of dentists without dealing with waiting periods. Discounts tend to range from 5% – 60% off the retail price of a dental procedure.
Another option for covering dental costs is to search for pro bono work. These are situations where a dentist may provide low-cost or free dental services, commonly as a way to give back to the community. Dental schools will occasionally offer this type of work as a way for a student dentist to learn alongside an experienced dentist.
Below are a few more resources that can assist low-income seniors with their dental needs:
|
Resource
|
Website
|
How They Help
|
|
Dental Lifeline Network
|
https://dentallifeline.org/
|
A charity that provides access to dental care for those who cannot afford it any other way. Beneficiaries must be 65 or older, medically fragile, or have a permanent disability.
|
|
Smiles for Everyone Foundation
|
https://www.smilesforeveryone.org/
|
A charity that has donated over $20 million in oral care services since it began in 2011. It runs programs that offer free basic dental services, extensive dental procedures, and dental implants. All patients must apply and be accepted.
|
|
Charitable Smiles
|
https://www.charitablesmiles.org/
|
A charity that matches those in need with dentists who will provide free dental care.
|
|
Care Credit
|
https://www.carecredit.com/dentistry/
|
A credit card designed to cover out-of-pocket healthcare services. This card provides months-long financing options and zero interest on costs above $200. The card is accepted at 250,000 different healthcare locations in the US.
|
The Financial Impact of Dental Insurance
Within the insurance industry, there’s some debate about the value of offering individual dental plans to customers. While it’s undeniable that the strict coverage limits of dental plans can cause problems, plans are still beneficial for many — it all just depends on the plan and the person. Below you can learn about financial factors to consider.
Did you know?
PPO plans are very similar to indemnity plans, which are also called Fee-For-Service (FFS). In PPOs, you get the best level of coverage within a predetermined network of dentists, and in indemnity plans, you typically get the same coverage regardless of network. Both plan types may have a network of preferred providers available, however. In indemnity plans, you also may be more likely to be balance billed (see “Key Financial Concepts in Dental Billing”). Otherwise, these two plan types are virtually indistinguishable. Much of the information below about PPOs also applies to indemnity plans.
The Financial Risks and Benefits of Using a Dental PPO
The Risk: Losing Money or Breaking Even on Premiums
It’s entirely possible and even common for a patient to put more money into a plan than the plan ends up paying out in benefits. To consider this possibility, it’s helpful to look at some hypothetical numbers. Suppose you purchase a plan that has $30 monthly premiums, a $50 deductible, and a $1,000 coverage limit. It covers 100% of preventive services, 80% of basic services, and 50% of major services. For this plan, your yearly spending on premiums will be $360. Note that deductibles are not usually charged for preventive care.
Now imagine that the plan covers twice-annual preventive visits that together are worth $300. If you only end up needing preventive care in a year, then you would essentially lose $60. If you only took advantage of one of the two cleanings available to you, you would essentially be paying $360 for about $150 of dental care, a loss of $210. If the preventive care were worth slightly more than $300 total, then it’s likely you would break even on the plan, meaning you could have paid out of pocket with less hassle.
The Potential Benefit: Saving Money With a Dental PPO
For the same hypothetical plan above, if you use more than preventive care in a year, then the plan may provide a significant financial benefit. Suppose that during the course of one year you got the same $300 worth of preventive care, plus you needed $250 in services classified by the plan as “basic” and $1,000 for services classified as “major.” The table below shows the breakdown of what you and the plan pay.
Cost Sharing for the Hypothetical Plan*
| You Pay |
Plan Pays |
- $360 for premiums
- $50 for the deductible
- $50 for your share of basic services (20%)
- $500 for your share of major services (50%)
|
- $300 for preventive services (100%)
- $200 for its share of basic services (80%)
- $500 for its share of major services (50%)
|
| = $960 total costs to you |
= $1,000 total cost to insurance |
*Note: This hypothetical situation does not address some of the more complex cost issues that can arise when plans have extremely specific coverage exclusions. This example also assumes that the patient is receiving care in-network, where coverage will be the best.
In such a scenario, you will have maxed out what the plan can provide to you for the year, but will have received $1,550 worth of care. In other words, you’ve paid for about 61% of your actual dental care costs, overall.
Other Options: Alternative Plan Types to Consider
As the above examples show, paying for a medium to high coverage PPO (or indemnity) plan is something of a gamble since you’ll likely lose a bit of money if you only end up needing preventive care. Moreover, most plans have waiting periods. If you can’t get a waiting period waiver, the plan might be less useful to you, depending on your situation.
If you still want a dental plan, but you think a high coverage option is unlikely to be a good deal for you, you can look into the following options instead.
Preventative-Only Plans
PPOs and indemnity plans are often available in preventive-only versions that are ideal for seniors who want a plan that incentivizes them to get regular checkups. These plans start at about $180 for a year, and if you utilize both preventive visits provided, you may save $100-$200 per year on that care. It all depends on the cost of care in your area and the exact terms of the plan, of course. Preventive plans usually don’t have waiting periods or annual maximums, but they cover few services. You’ll be paying for any fillings and other work out of pocket, though a small discount may be provided as a courtesy.
HMO Plans
These plans, which are structured completely differently from PPOs, often cost $8-12 a month. They are restrictive, limiting the patient to only visiting one local dentist. Seeing a specialist requires a referral. On these plans, you’ll pay for care based on a list of copays, many of which are quite low ($10, $20, or $50 in many cases) for the most commonly utilized services. There are also no waiting periods, deductibles, or annual maximums. HMOs are available in a few states, and patients may sometimes wait a while for appointments due to poor dentist-to-patient ratios in the network. Scrutinize the network and copay list to see if coverage is a good fit.
Discount Plans
Dental discount plans may cost you between about $70-$150+ in a year. These plans do not qualify as insurance. Instead, they merely offer patients access to a network of dentists that have agreed to treat patients at discounted levels. With no waiting periods, deductibles, or yearly maximums, they provide flexibility. They can offer discounts on services like teeth whitening or orthodontia that aren’t covered by most PPOs, too. You’ll have to pay for all of your own care out of pocket, but you may find that you save several hundreds of dollars a year through discounts ranging from about 5%-60%, depending on the plan. These plans can help manage costs for those who need major work right away. Always check the discount network carefully to make sure it includes the dentist(s) you want to visit.
The Financial Impact of Dental Exclusions for PPO Patients
Companies have the freedom to specify coverage exclusions that may render a plan unhelpful in situations when you need financial assistance the most. Exclusions are the reason you always need to read every page and paragraph of a plan’s “Schedule of Benefits” and other documents before signing up. Some limits, like the exclusion of cosmetic work and orthodontia for adults, may not matter to you at all. Others should give you pause, particularly if the plan’s premiums are high. Below you can explore examples of exclusions so you know what to look out for in plan documents.
Common Coverage Exclusions:
- Total Exclusions: The plan may state that a certain category of work or a certain procedure/item is entirely excluded, with no exceptions.
- Materials/Method Exclusions: If there is more than one way to treat a dental issue, the company may specify that it only covers the lower-cost option, regardless of what the dentist recommends.
- Age-Based Limits: Some care is only covered for children. Typically if orthodontia coverage is advertised in a plan, the fine print indicates it’s unavailable to those over age 19.
- Time Period Limits: The plan may cover a procedure like an implant, but it may specify that it only covers 1 implant per 5 years, regardless of your actual need (this is a real example from a popular plan). The exact number of times an item is covered per time period will vary.
- Lifetime Maximums: Expensive dental items/services may be placed in their own coverage categories, and that category may have a special “lifetime limit” such as $1,000. This is especially common for dentures.
- Pre-Existing Conditions Exclusions: Some plans state that they won’t cover issues that existed before coverage began. For example, if you got a crown in the past, but the crown breaks while you’re under the plan, the plan may refuse to cover its replacement since the problem began before coverage started. In such cases, even waiting period waivers cannot help your situation.
How Dental Offices and Insurance Companies Handle Insurance Claims
If you’re going to sign up for a PPO or an indemnity plan, it’s smart to learn how dental billing works for those plans. Although the information below is quite technical, it will help you fully understand your situation if, in the future, your plan refuses to pay the portion of a bill. This information is particularly important if you choose an indemnity plan or if you get a PPO but chose to use out-of-network providers. In both situations, balance billing, discussed below, might be an issue for you.
Key Financial Concepts in Dental Billing
| Concept |
Definition and Context |
| Usual and Customary (UC) Charge |
This is the amount that the dental provider (dental office) always charges for a given service. |
| Usual, Customary, and Reasonable (UCR) Charge |
This is the maximum amount of money that the insurance company sees as a reasonable cost for a particular service. The insurance company commits to pay a certain percentage of the URC, and the patient is often liable for a percentage as well. |
| Balance Billing |
If the dental office’s UC is higher than the insurer’s URC, the dental office might bill the patient for the difference. |
| Write-Offs and In-Network Providers |
Dentists that want to be considered in-network/preferred providers must sign contracts. Many network dentists have contracts in which they automatically discount the UC for patients who are on a particular plan. The contract may also forbid them from balance billing the insured patients. PPO plans usually forbid balance billing in their network, but indemnity plans, which allow greater freedom to choose providers, often allow it.
If balance billing is forbidden but the UC happens to be greater than the UCR, then the dentist cannot legally attempt to make anyone pay the difference. The dentist simply takes a loss, writing off the remaining portion of the bill. |
