Top Questions to Ask Before Choosing Dental Insurance

Before you choose a dental insurance plan, there are some important considerations to take into account. These considerations include how you expect to use your dental coverage, what type of insurance is right for you, and what specific plan is the best fit. By asking these questions, you can choose the most cost-effective insurance option that still covers all your needs.

Top Questions to Ask Before Choosing Dental Insurance

Having dental insurance can help make accessing routine dental care more affordable and accessible to you and your family. According to research from the National Association of Dental Plans, those with dental insurance are more likely to go to the dentist, take their kids to the dentist, receive restorative care, and have better overall health.¹

Dental plans may cover 100% of preventative care, like cleanings and checkups, which makes staying up to date on your oral health affordable. Reviewing the questions below and doing your due diligence before choosing a dental plan will help you find the best plan for you.

Understanding dental insurance basics

There are four main types of dental insurance. Here’s a quick look at each:

• DHMO: Dental HMO plans will have you select a primary care provider, who is a dentist who will oversee your dental care and will coordinate specialist care for you if needed. For instance, you may see your primary care provider for cleanings, checkups, and services like fillings, but your dentist may refer you to a specialist if you need to have a more advanced procedure. This type of plan will likely have no deductible, but they may have annual benefit limits or require copayments.² These dental plans are a bit more limited, since you must see one specific dentist, but they usually cost less compared to PPOs.¹
• PPO: Dental PPO plans are the most common kind of dental insurance, making up 89% of all commercial dental policies.¹ PPOs often offer a wider range of providers to choose from, as you can choose to see any in-network dentist or pay more to see an out-of-network dentist, if you prefer. PPOs usually have deductibles and annual benefit limits, and cover a certain percentage for dental procedures.² In contrast to HMOs, you may pay a higher premium, but have greater flexibility when selecting a provider.³
• Dental indemnity plan: Dental indemnity plans are also called traditional dental plans, and they work similarly to health insurance plans. You can see any dental care provider that accepts your plan. Like health insurance, you will generally pay a premium, and may have a deductible and/or a copayment.²
• Dental discount or savings plan: Dental discount or savings plans offer discounted rates from dental providers who participate in the plan. Since they aren’t traditional insurance plans, you’ll usually pay a membership fee, but not have deductibles or annual limits.²

The right insurance option for you might depend on what your employer provides, what you can afford to pay, and what dental services you plan to use. But no matter what you choose, having dental insurance can help you and your family and access the care you need and manage costs.

And remember: Your oral health is closely related overall health, with dental issues linked to conditions like diabetes, cardiovascular disease, dementia, and more.  So maintaining healthy teeth and gums is important beyond your smile.

Key questions about coverage and exclusions

When you start looking at dental insurance plans, here are some important questions to ask:

What does the plan cover?

Many dental plans fully cover preventive care, like routine cleanings and check-ups. Most plans will cover basic procedures — such as fillings, root canals, gum disease treatments, and extractions — at a certain percentage or copayment. Coverage for major procedures, such as crowns, dentures, inlays, and bridges, will vary depending on your plan. The cost for major procedures will generally be higher than for basic procedures.¹

What does the plan exclude or limit?

Most dental plans won’t cover cosmetic procedures (like teeth whitening or veneers), but there may be other treatments or procedures a specific plan doesn’t cover. Some plans have frequency limitations; for instance you might not be able to get more than two cleanings per year covered.

Most plans also have annual limits and some may even have lifetime limits to how much they’ll cover in a year or over the time you’re enrolled.⁴ Plans may also have waiting periods, meaning that a certain amount of time must pass before you are eligible for coverage.⁵

How does this plan work for me?

If you don’t expect needing any major dental work in the year ahead, coverage limits and annual maximums might not concern you as much. But if you are expecting to get extensive dental care, you’ll want to make sure that the costs limits are manageable. Run the numbers and make sure you’re selecting a plan that’s right for you.

Questions about costs and affordability

Of course, cost is a major consideration for dental insurance. Here are some questions to consider as you look at plans:

What is the total cost?

Take a look at the premium (the monthly fee you pay for a plan), the deductible (the amount you will need to pay out-of-pocket before insurance kicks in), the copay amount (how much you will need to pay for each visit), and the out-of-pocket maximum (how much you’ll have to pay before insurance begins to cover everything).

How do costs vary by plan type and provider?

Different plans will have different cost structures for your premium, deductible, copay, and more. A lower premium may not always mean you will pay less overall for the services and treatments you may need. If you get your dental insurance through your employer, you may not have many options, but if you do have multiple choices, be sure to do a thorough comparison.

Are there affordable dental insurance options or cost calculators?

If the dental insurance options you’re finding seem out of your budget, you may be able to find a more affordable option by getting your dental care at a local dental school, a federally-qualified health center, or a dental health nonprofit.⁶  You can also use a dental cost calculator like FAIR Health Consumer’s to get an idea of what a specific procedure might cost you.

Comparing dental insurance plans

When you’re doing your dental insurance comparison, here are some key factors to consider:

• Cost: Be sure to compare premiums, deductibles, copays, out-of-pocket maximums, and any other costs for services and treatments you and your family may need.
• Coverage: While cost may be a big consideration, you also want to make sure your plan covers what you need. For instance, if you know you want to get braces, you’ll want to check if your plan covers orthodontic services.
• Dentist network: If you have a dentist you like, you might want to check if they’re in-network for the plan you choose. If you don’t have a preferred dentist, you may still want to check to ensure there’s a decent number of options in your area.
• Reviews: Check online to see what other peoples’ experience have been like with various dental insurers. Ask co-workers or friends and family, too.
• Your unique situation: Do you have a large family? Are you a senior? Children and seniors have unique dental care needs — children might need braces, and seniors might need dentures, for instance. Check that policies offer coverage for services you may need.

How MetLife can help you choose the right dental insurance

Whether you’re comparing coverage options, costs, or provider networks, MetLife provides clear plan details, cost estimators, and customer reviews to help you make an informed decision.

MetLife offers dental insurance plans for everyone, including seniors, families, federal employees, and veterans. Depending on your employer, or if you’re in the military, MetLife plans could provide coverage for preventive care, basic and restorative services, major procedures, and orthodontics. Plans are designed to cover members of all ages, thought treatment frequency and age limitations may apply.

What’s more, MetLife offers extensive network of providers, including those with the SpotLite on Oral Health designation. This designation is given to in-network providers that meet certain criteria for preventive oral health care.

Questions about dentists and networks

There are also questions to consider about the dental network plans offer. A dental plan may require you to see an in-network dentist to get the best price. Here are some questions to get answers to as you do your research:

Is your preferred dentist in-network?

If you have a dentist you want to stick with, check to see if their office accepts your dental insurance and if they’re in your network. You may be able to save money if they are in-network.

How large is the provider network?

Even if you think you know who you want to see, what if you move or decide to see someone new? Take a look at the network to see if there’s a wide enough range of providers for you to choose from.

What happens if you need out-of-network care?

Ideally, you’ll stick with in-network dentists, but what if, say, you need to see someone out-of-network for an emergency? Check the plan’s policy on how they handle out-of-network care. For instance, a PPO typically will provide some coverage for a dental provider outside the network, while a discount plan would limit you to participating dentists. ⁷

Dental insurance vs. dental discount plans

If you’re comparing a dental insurance plan to a dental discount plan, here are some questions to ask:

How do dental discount plans work?

Dental discount plans are relatively straightforward — you pay a fee to access a network of dentists that have agreed to offer discounted prices for their services. Your plan will let you know exactly what the discounts are, and you will pay the dentist instead of billing insurance.²

How do they differ?

Discounts plans have a membership fee, unlike premiums with insurance. With a discount plan, you will pay the dentist directly at the negotiated discount rate, and there are generally no deductibles or annual limits.²

Which option is better for your needs?

Compare the discount plan to an insurance plan by looking at total cost, what’s covered, if your preferred dentist is in-network and if the network of providers is sufficiently large. Also, check whether specific procedures you’re seeking are covered.

Questions about preventive care and claims

Preventive care is an important part of dental care, and something you should schedule regularly. Here are some things to consider when you compare dental policies on preventive care and claims:

What preventive services are covered?

Preventive care usually includes dental cleanings, exams, and x-rays, and plans may cover them entirely. 

How do you file a dental insurance claim?

Your dentist’s office will generally file the claim for you, using the dental insurance information you provide. If you have to file it yourself, request a detailed invoice from your dentist and follow the instructions for your insurance company’s claim process.

What information is needed for claims?

A dental claim form will typically require your information, your dentist’s information, the date of service, a description of the treatment, and a diagnosis code.⁸ Check with your insurer to be sure you have all the information you need before you submit a claim, if you need to do it yourself.

Choosing the right dental plan

By understanding the costs and coverage for different plans, you can make the choice that serves your dental needs in the most cost-effective way.

Carefully reviewing the cost, coverage, network, and reviews, and analyzing how they apply to your needed dental care will help you find the best dental insurance plan for you. By making consistent dental care accessible and affordable to yourself and your family, you can set yourself up to have great oral health, financial health, and overall health.