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A Guide To Individual Dental Insurance

It is widely known that most insurance plans don’t cover dental procedures, which is why you have to look specifically for dental insurance. Dental care is important since, over time,…

September 27, 2022

Written by Trey Bongiovanni

It is widely known that most insurance plans don’t cover dental procedures, which is why you have to look specifically for dental insurance. Dental care is important since, over time, poor dental hygiene can lead to gum disease, tooth decay, and other serious health problems.


It’s important to know what your dental insurance covers and what it doesn’t cover. Some procedures may be covered, while others may not be. It’s also important to know the different types of dental insurance plans. In this post, we’ll discuss what dental insurance is, what it covers, its benefits, how to enroll, and more.


What’s Dental Insurance?

Dental insurance is a type of insurance that helps cover the cost of dental care. There are many different types of dental insurance plans, and each has its own benefits. Some plans may cover preventive care, while others may cover more extensive procedures.


Individual Dental Insurance

Individual Dental Insurance generally provides coverage for anything dental-related, including examinations and x-rays. It typically does not cover any major expenses such as dentures, crowns, bridges, or root canals. Turning to Individual Dental Insurance is a good idea if the policyholder has health insurance, dental insurance, or both that don’t meet their individual needs. Most Individual Dental Insurance plans provide coverage benefits much less expensive than Medicare or Medicaid in most states.


Basics of Individual Dental Insurance 

Individual Dental Insurance is a commercial dental insurance plan. It may be offered under one or more of the following three different types of plans: 


  • Fee-For-Service Managed Care
  • Preferred Provider Organization (PPO). 


There are two major factors to consider when comparing Individual Dental Insurance plans: medical and dental. A medical plan provides reimbursement for medical expenses incurred. A dental plan provides reimbursement for any dental expenses incurred due to an accident or illness. The first step is to decide if you want to compare plans by medical or dental expenses.


Factors To Consider When Choosing Individual Dental Insurance

Individual Dental Insurance is a great solution for someone looking for dental insurance that meets all of their needs but doesn’t want to pay too much. It’s important to compare different Individual Dental Insurance policies to get the best possible price and coverage. Several factors may affect how much the policyholder will spend on this type of insurance. Here are some of the factors:

Health Insurance.

If the policyholder already has health insurance, it’s important to remember that any expenses incurred for dental issues will be covered by their medical insurance plan.

Medicaid Eligibility.

Medicaid is a government-sponsored health insurance program that covers low-income individuals and families. Unfortunately, it doesn’t cover dental expenses except in extreme emergencies such as cancer or the death of a family member. However, dentures may be covered under Medicaid in some instances. For this reason, denture coverage may not be very important in states with Medicaid dental benefits.

State Of Residence.

In some states, Medicaid covers dental benefits such as root canals, bridges, and tooth extractions for adults and children. Most states do not offer dental coverage as part of the Medicaid program; therefore, there is high demand for Individual Dental Insurance plans that cover these types of expenses.


Dental insurance policies typically have annual maximums on certain procedures or Categories of Expense and per-person maximums. Determining the limits is important to know how much you will spend under the plan. For example, one Individual Dental Insurance policy may limit orthodontics coverage to $1,000 per year for all services combined.


The deductible is the amount you must pay from your pocket before the insurance company begins to cover expenses. The policyholder will typically be responsible for 100% of the cost for any dental services not listed in their plan until they meet their annual or individual deductible. Any covered services after that will be paid at an agreed-upon percentage (usually 80%) by the insurance company and 20% by the policyholder.


Not all Individual Dental Insurance plans cover the same expenses. Some may be more comprehensive with their coverage, and others may be more limited. For example, one company may only cover a specific procedure such as in-office root canals, whereas another plan covers crowns because of a cracked tooth.


Types Of Dental Insurance Plans

There are two common types of Individual Dental Insurance policies: fee-for-service and managed care. Fee-for-service plans are the least expensive but also the most flexible. A managed care plan is more expensive, but it typically covers only dental care from a select list of providers and in a specific service area, such as within a single state or local metropolitan area. Here are other types of Individual Dental Insurance:

Standard Dental Insurance Plans (Also Known As Indemnity Plans)

These are the most popular types. The plan provider pays a certain amount towards covered services. Regular check-ups to maintain oral health are usually not covered by this type of policy. Most standard Individual Dental Insurance plans have several different coverage options, making it more difficult to compare them.

Comprehensive Dental Insurance Plans

These plans cover all dental services, including regular check-ups, cleaning, and preventative treatment. The plan usually covers special dental procedures such as implants, crowns, and dentures (but not fillings).

Preferred Provider Organization (PPO)

A PPO is a type of managed care dental insurance. It pays a set amount per person per year to each dentist providing covered services in the plan’s service area. Managed care plans typically have a narrower provider network than standard Individual Dental Insurance plans.

Discount Dental Insurance

Dentists and dental care providers usually offer Discount Individual Dental Insurance. It offers a reduced price for services received. It is not designed to cover all dental expenses but can be an option for those who want to save some money on dental visits.


Individual Dental Insurance isn’t always necessary, and dental care can be very affordable if you choose your dentist wisely—even if you do not have insurance.


Advantages Of The Dental Insurance Plan

The biggest advantage of Individual Dental Insurance is that it protects the policyholder from having to pay out-of-pocket for required preventive treatment and dentures. This is especially important if you’re on a limited budget. Here are other advantages of dental insurance:

Protection Against Unforeseen Dental Expenses

Most types of insurance do not cover regular check-ups to maintain good oral health. If you choose the right policy, your premiums will be manageable, which means that any out-of-pocket expenses for dental care will also be affordable. However, even if you have a great plan with affordable premiums and low out-of-pocket expenses, it’s still smart to be diligent about preventive care and regular visits to the dentist.

Invest In Your Dental Health

Even the best Individual Dental Insurance plans have maximum amounts for certain procedures or Categories of Expense. For example, one plan may limit coverage for crowns to $1,000 per year for all services combined, which means that a person who needs three crowns in one year would need to pay $4,000 out-of-pocket (some plans are capped at two crowns per person per year). The right Individual Dental Insurance plan can give you the financial freedom to invest in your dental health while protecting you from paying out-of-pocket expenses.

Dental Discount Plans

Discount Individual Dental Insurance or Discount Dental Plans are available from many dentists but won’t protect you from the financial risk of dental care. Also, some plans require enrollees to pay a large deductible before they can start saving any money on their dental care.


One of the most important advantages of Individual Dental Insurance is that it allows you to see the dentist of your choice and schedule the best appointments.

Preventative Treatment

A well-planned Individual Dental Insurance plan can protect you from the cost of serious dental problems such as root canals (covered by most plans), cavity fillings, tooth extractions, and gum disease treatment.


How to Enroll For Individual Dental Insurance


Decide Your Plan

Decide whether you want to go with a standard or comprehensive plan. Standard plans will enable you to see any dentist/orthodontist in the policy’s service area. A comprehensive policy, on the other hand, will have limited coverage. A third party will choose the coverage providers, and they may not necessarily be in your area of choice.


Your plan has to cover all your necessary services (dentures, extraction, bridges, and so on). If your plan does not cover your services, you may need to get a supplemental plan. If you are not sure about the coverage of your insurance plan, contact the local agent or company and discuss this in detail.


Check The Clauses

You also need to check for pre-existing condition clauses. Most Individual Dental Insurance plans do not cover certain procedures if you have a pre-existing medical condition. It is better to discover these conditions before enrolling in an Individual Dental Insurance plan. If you suspect your child or spouse has a pre-existing condition, you should also consider this.



Once you have found out about your plan coverage and have ensured that the conditions are suitable, enroll in the Individual Dental Insurance plan by paying the enrollment fee. You can choose to make monthly premium payments or pay one time for a whole year. If you choose to make monthly payments, it is better to opt for direct debit so that the premiums are automatically taken from your account every month. Once you have enrolled in an Individual Dental Insurance plan, you can start saving money on your dental costs for the health and benefits of the client.


Plan Your Benefits

Do you plan to have an Individual Dental Insurance Plan? At Nesso Benefits, we provide integrated financial and insurance plans to individuals, families, and groups. Our comprehensive solutions, individualized care, and superior customer service make us the right fit to help you develop a comprehensive health and benefits plan.


Our Nesso Group team strives to provide clients with innovative, individualized, and cost-effective plans with broad-based coverage. We provide Individual Dental Insurance Plans designed to customize our clients’ health and benefits. Don’t hesitate to reach out today.



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