What Is Dental Insurance?

Dental insurance is a type of health insurance to help cover costs associated with dental care. Dental insurance is separate from typical medical insurance, although many employers can offer employees a combined benefits package that includes medical, dental and vision insurance. 

At Health Plans of NC, we specialize in helping people living in North Carolina with their health and dental insurance needs. Our knowledgeable agents can discuss your needs and determine the best dental insurance plans to meet your circumstances and budget. 

What dental insurance covers?

Insurance providers typically bundle dental and vision insurance in a single plan; your benefits and the cost of your coverage can depend on your plan type. 

To find out your level of coverage, check your policy carefully. Most typically provide access to a free or low-cost preventive cleaning and routine dental exam. In addition, some plans help to cover the cost of fillings or extractions after meeting your deductible. 

Some plans can help to cover the cost of more extensive dental work, including crowns, root canals and endodontics. However, be mindful that usually, these services require you to complete waiting periods, or there may be restrictions and annual financial coverage caps, so check your policy carefully.

How much does dental insurance cost? 

In North Carolina, stand-alone or family dental coverage premiums can range between $42 to $102 per month. If you're interested in purchasing coverage via the Health Insurance Marketplace, be aware that any premiums associated with dental coverage for children may or may not be offset by premium tax credits. To check, speak to a health insurance agent like Health Plans of NC, who knows how different dental insurance plans work in North Carolina. 

Dental costs for children

If you purchase a stand-alone pediatric dental plan from the North Carolina Marketplace, it will comply with the Affordable Care Act's (ACA) pediatric dental coverage rules. This means your out-of-pocket costs for dental care for your child won't exceed $375 per child in 2022 (or $750 for all children on your family plan). There's also no cap on any medically-necessary dental benefits for your children. 

If you have a family health plan with pediatric dental coverage, the dental costs can count towards your overall deductible, so keep in mind that your out-of-pocket costs may be affected. 

Does Medicare cover dental care?

Routine dental care isn't covered under Medicare, and coverage for any dental expenses is only applicable when treatment is integral to other medical treatments. For example, needing to extract a tooth before starting radiation treatment. However, if you're over 65, you may wish to consider Medicare Advantage, as most plans typically provide some dental coverage. 

Types of dental insurance

Dental health insurance plans are either:

Managed care plans: offering a network of participating dentists you can access for dental care, or;

Indemnity plans: allowing you to pay a set amount for a specific service, regardless of the dentist you visit.

Dental managed care plans are typically HMOs or PPOs (for dental care, these are called DHMOs and DPPOs). These types of plans only cover services provided by dentists in your insurance provider's network and usually require your primary care dentist to give you a referral if you need to see a specialist.

Your insurer may cover some out-of-network visits, but generally, the costs will be higher if you see a provider outside your insurance provider's preferred network. 

Buying a dental insurance plan

In North Carolina, not all insurers offer medical plans that include dental coverage. However, you can purchase stand-alone dental plans that cover adults and children. 

Dental insurance is generally available through the ACA's Health Insurance 

Marketplace. However, you can only purchase during open enrollment or a special enrollment period. It's also usually only available to purchase with an ACA-compliant health plan.

If you're looking outside the open enrollment period, you'll need to look for a plan sold directly by dental insurance companies or dental offices. These plans aren't subject to the ACA's rules relating to dental coverage for children, but the North Carolina Department of Insurance regulates them. If you're looking for a private dental plan, our locally based health insurance agents can help. 

Dental coverage under Medicaid

If you're enrolled in Medicaid in North Carolina, you're eligible for dental services with no limits on annual spending. 

Need help finding the right level of coverage?

Speaking to a locally based health insurance broker can help ensure you get the right coverage for your needs. We can help you find dental insurance no waiting period and answer any questions you have about your dental insurance options. Contact our team today at Health Plans of NC to find out more.