What is Supplemental Dental Insurance?

Supplemental dental insurance is purchased to fill the gaps in a policy holder’s dental or medical coverage. Gaps in coverage can occur when the primary policy’s annual spending limit is reached, or when a policy doesn’t provide coverage for necessary or desired dental treatments.

This article outlines the most typical scenarios that result in a need for supplemental dental insurance such as Medicare, limited or no dental insurance, or obtaining coverage for treatments such as braces, root canals, crowns and dental implants that may not be covered by insurance or may cost more than an insurance plan’s typical maximum spending limit.

The article also provides guidance on how to coordinate dental insurance benefits when using a supplemental or savings plan.

Supplemental dental insurance for Medicare

Medicare does not cover dental care or treatments such as cleanings, fillings, tooth extractions, dentures, bridges, root canals or crowns. There are a few extremely limited exceptions to this rule – for example, if you need to be hospitalized to receive complicated or emergency dental treatment, Medicare Part A (Hospital Insurance) may cover inpatient costs but not the fees associated with the actual dental treatments.

Consequently, Medicare recipients tend to look for broader health coverage through a Medicare Advantage program – a Medicare-sanctioned, regulated program offered by private health insurance providers. These plans are widely considered to be supplemental coverage, even though they are technically providing an alternative to the basic Medicare offering.

Some Medicare Advantage plans do include dental benefits, others do not. Check the plan’s documentation to determine if dental is included. Then look at how many providers are in the plan’s network, and whether your dentist accepts the plan. And check to see if the plan offers any additional benefits that matter to you as well, some Medicare Advantage plans provide vision and prescription coverage/savings along with dental.

If dental services are covered, check to see if you’ll need to pay an extra monthly premium for dental coverage, whether there is a deductible and an annual spending cap, and what your co-payment for services will be, and whether it offers comprehensive coverage or just preventive care. And check to see if the plan has a waiting period before coverage is available, and whether any pre-existing dental problems you may have will be eligible for treatment under the plan.

Other options for Medicare policy owners include buying a standalone dental policy from a private insurance company or joining a dental savings plan.

Unlike dental insurance, dental savings plans don’t have an annual spending limit. That makes these plans an excellent option for those who need restorative treatments such as root canals, crowns, dentures and other costly services. Not familiar with dental savings plans? Continue reading or cut to the chase and click here to learn more about how these plans work.

Supplemental dental insurance for existing dental coverage

Dental insurance typically limits a plan’s annual coverage – the amount the plan will pay for each year – to $1000-$1500.

This presents no problem if you just need preventive care and perhaps a small cavity filled. But with the average cost of a single root canal on a front tooth ranging from a low of $700 to $1,300 (depending on where you live, and what a particular dentist charges), and another $500-$1000 for a crown that’s often necessary following a root canal, it’s all too easy to exhaust your dental allowance in a single visit or two. Another dental budget-buster are braces, which cost from $3,000-$7000 or more over the course of the treatment.

Supplemental insurance would seem to be the answer if you have exceeded your dental insurance plan’s annual maximum or if your plan does not cover a needed procedure. But before you pay more for yet another insurance policy, consider potential problems and your options.

A new-to-you dental insurance plan may not cover work in progress or preexisting conditions. Plus there will almost always be months-long waiting period before you can get reimbursed for major procedures such as crowns or root canals.

And it can be difficult to coordinate benefits from two dental insurance plans. Make a mistake, and your insurance claim can be denied, leaving you liable for the cost of care. Make sure your dentist knows that you will be using supplemental insurance to cover a percentage of the costs.

Coordinating dental insurance benefits

Whether you’re using supplemental insurance, a second dental insurance policy, or a dental savings plan you should be aware of whether your primary plan has any rules about coordinating benefits. Coordinating benefits is a complicated issue, and you should speak with your dentist, HR if your plan is provided by your employer, or your insurance provider.

Basically, coordination of benefits comes down to deciding which insurance plan is the “primary payer.” Rules vary across plans, in some cases if you and your spouse both have dental insurance plans which cover your children, the plan belonging to the spouse whose birthday falls earlier in the year will be the primary payer. In other words, if you’re born in January and your spouse’s birthday is June, your plan is the primary payer – assuming there are no other rules in place.

Even if your family is covered by two dental insurance plans, the second plan is considered supplementary. You won’t get double of everything – 4 free cleanings a year as opposed to 2, for example. The secondary plan only fills in the gaps left by the first plan, but do check each’s plans “non-duplication of benefits” provisions for information specific to your plan.

Using dental savings plans to supplement insurance

Dental savings plans, an alternative to traditional dental insurance, offer an exceptionally easy way to get affordable dental treatment quickly with no worries about annual spending limits, pre-existing conditions or waiting periods. Dental savings plan members report saving an average of 50%* on their dental care.

Some people find that their needs are best met by having both traditional dental insurance and a dental savings plan. Families with young children may want insurance to cover preventive care for the little ones, and a savings plan to make adult care more affordable. Or you might want to get a dental savings plans to bridge the gap between insurance-mandated waiting periods for some procedures or buy a dental savings plan when the treatment you need will cost more than your dental insurance policy’s maximum annual spending limit.

In addition, some dental savings plans offer discounts on some dental specialties that are rarely covered by dental insurance, including cosmetic dentistry services like veneers, teeth whitening and more. Those who need or want these treatments often buy a dental savings plan membership to get a discounted rate on the services.

For dental insurance plans, the best thing you can do is ask plenty of questions before purchasing, and don’t hesitate to get your dentist’s opinion on which insurance plan meets your dental care needs. If your employer-provided group plan doesn’t meet your unique needs, rest assured you can fill in any gaps in your dental coverage with a supplemental insurance policy or a dental savings plan.

Want help choosing the dental insurance or dental savings plan that’s right for you? Give us a call at 1-833-735-0399. If you’re considering a dental savings plan, you can also use our calculator below for a quick look at how much you can save on virtually all of your dental care.

*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.