Despite its importance for overall health, dental wellness gets less attention than it should. Dental coverage isn’t considered “essential” for adults under the Affordable Care Act (ACA) health plan regulations, so those who want dental coverage often need to find it outside of their primary insurance. Without help from Medicare or Medicaid, seniors may feel lost when trying to find a privately offered dental plan that meets their needs.
Though not considered necessary by the US healthcare system, being without a dental insurance plan may have a detrimental effect on oral health over time. A survey conducted by the National Association of Dental Plans in 2007 revealed that those who have dental coverage are 49% more likely to have received preventative care like an exam or cleaning within the past 6 months than those who did not have coverage. Missing out on simple preventative care can lead to big problems in the future, as decay and other issues only intensify over time. Having a dental insurance plan can provide financial help as well as a psychological incentive for patients to visit a dentist on a regular basis.
Currently, of all the dental plan types available, Dental Preferred Provider Organizations (DPPOs, or just PPOs) are the most common. Other options include indemnity plans, which are quite similar to PPOs, and Dental Health Maintenance Organizations (DHMOs or just HMOs), which are less expensive but more restrictive in terms of which dentists patients can see. With so many options available, seniors may feel overwhelmed when trying to select a dental insurance plan. This guide will help take the confusion out of shopping for these plans. We researched PPOs and other coverage options offered by industry leaders, ranking them according to several metrics related to cost, coverage levels, and more.
Overall, we found that Humana, MetLife, and Surebridge had some of the most competitive options on the market. The other five companies that we ranked also have a lot to offer. Explore each company’s 1-5 score below, then learn more about how we evaluated each. You can scroll to the bottom of the article to learn about the financial impact of dental insurance and see answers to some frequently asked questions about dental insurance plans.
In ranking the top dental insurance companies, it’s important to use consistent standards when making comparisons. Below you can see the core metrics that we used to evaluate each company.
|Company||Overall Score (1-5 Scale)||Company Reputation and Reliability||Plan Variety||PPO Coverage Limitations||PPO Costs||Dental Insurance Alternatives|
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.
Many slight variations exist from company to company, so read plan documents carefully.
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.
Ranking in 5th place, Humana’s score was 4.2/10. Of the companies we reviewed, Humana had the best 2019 J.D. Power’s Dental Insurance Customer Satisfaction score with 780/1,000 (the highest company in that survey scored 810). Humana ranks at 52 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 and IAIC. Its company history, although dating back to 1961, is also shorter than many competitors whose histories date back into 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 four 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 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 just a 3-month waiting period for basic services, and its Loyalty Plus PPO has no waiting periods at all. Its “Complete” PPO has more typical waiting periods of 6 months and 12 months for basic and major services, respectively. Those interested in this plan may qualify for a waiting period waiver if they can prove they were previously insured for a year or more. Humana’s highest yearly maximum for the first year of coverage was $1,250, compared to MetLife’s at $2,000. Its highest yearly maximum reachable in a loyalty plan was tied with Guardian at $1,500. For comparison, Surebridge’s loyalty maximum was $2,000, Renaissance’s $3,000, and all other companies lacked plans with increasing maximums.
Humana scored 7/10 points, ranking in 3rd place. It has premiums starting at $16 per month, just $1 more than the lowest premium of $15 from Surebridge. Humana’s coinsurance levels were typical on most plans, with customers paying 0% for preventative, 20% 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.
Humana scored 2/10 points in this category, ranking in 5th place ahead of three companies that scored 0/10. Humana’s Dental Discount Plus plan offers discounts averaging from 20%-40% with a network of over 160,000 dental locations. The plan includes discounts on some non-dental services, too. Unfortunately, the plan’s pricing is listed in a confusing way. Online, monthly payments appear to be $6.99, but the company also charges a monthly $1 “administrative fee,” making its true annual cost about $96 (tied with Cigna and Renaissance). Moreover, a one-time fee of $15 brings first-year costs to $111. Those interested in Humana’s discount plan should note that payments can only be made monthly and that it is currently not offered in Washington, Hawaii, and Nevada.
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. No dental insurance plans are offered in Alaska, Hawaii, Washington, Rhode Island, Montana, or Vermont, though the majority of those states do have a dental discount plan. Many states only have one or two plan options, though Humana’s full dental insurance product catalog includes 5 insurance options plus a dental discount plan.
MetLife ranked second overall, scoring 4.5/5 stars, just 0.1 points behind Humana. Although not ranked 1st in any submetric, MetLife is a strong company overall. Its best metric is PPO Costs, with the company earning second place with 8.4/10 points thanks to the availability of some very low premiums and deductibles. This company performed well in most other metrics, earning third place in Company Reputation and Reliability, PPO Limitations, and Insurance Alternatives. However, MetLife ranked in 6th place in Plan Variety due largely to its low number of plans and lack of specialty options like loyalty plans and bundles.
With 7/10 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 2nd best in the Fortune 500 ratings with a ranking of 48. Founded in 1868, this company is the 4th oldest company we reviewed. Its rating on Google 3/5 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 2.8/10, ranking in 6th place. This is one of four 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, 5, was tied with Humana and Renaissance for 2nd place. The highest number of plans available is 9 from Surebridge. MetLife struggles to keep up when it comes to specialty plans, offering neither a loyalty PPO nor a bundled benefit plan.
MetLife scored 7/10 points in PPO Limitations for 3rd 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. 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 2nd place with 8.4/10, MeLife performed best in this metric. Across MetLife plans, patients pay 0% for preventative care and 50% for major services if major services are covered. Coverage levels for minor services vary, but patients pay as little as 20% 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, just a little higher than Surebridge’s $15 quote and Humana’s $16 quote.
Scoring 6/10 points, MeLife ranked 3rd out of 6 places. 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 Carington 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 highest cost on our list, with an annual premium of $143 for a single person. Customers can opt to pay monthly or annually, and the cost is the same either way.
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.
Overall, Surebridge scored 3.6/5 stars for 3rd place. Strongest in PPO Costs, Surebridge scored 10/10 for first place in that metric due to its very low starting costs for premiums. 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.
Surebridge ranked in 8th place with 0/10 points. 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 1.7/5 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.
Ranking in 5th place with 4.2/10 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. The highest number of plans offered by any company is 9. 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 4th place with 4.6/10 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. To get Surebridge’s 6-month basic services and 12-month major services waiting periods waived, you need to prove that you previously had full dental coverage for at least 12 months and that that coverage was active within 63 days of your application to the Surebridge plan.
Surebridge ranked 1st, scoring 10/10 points in the cost category. Its PPO Basic plan, a low-coverage option, has a monthly premium between $13-$15, lower than any other competitor we reviewed. Surebridge had a $50 deductible on most plans, though on its DVH plan its deductible was $100 for combined dental, vision, and hearing benefits. On its fullest coverage plans, patients pay 20% for basic services and 40% (as opposed to 50% elsewhere) for major services. On all Surebridge plans, paying 0% for preventative care is standard.
Surebridge is one of three companies we reviewed that offers no discount plans as alternatives to traditional insurance. Like IAIC and Guardian, Surebridge scored 0/10 points in this category, ranking together in last place.
Surebridge plans are readily available on both broker sites and through the Surebridge website and 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.
In 4th 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.
Landing in 4th place, Aetna scored 5.6/10 points. With a company history dating back to 1853, Aetna has the 2nd most amount of experience in the industry. Its JD Powers’ score is also 2nd best at 760/1,000, 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 2.8/5 stars on Google reviews ranked in 5th out of 8 places in that submetric. Aetna’s Google profile score is based on 67 reviews.
With a Plan Variety score of 1.4/10, Aetna keeps its plan selection simple, ranking in 7th place. This company’s only dental insurance style is PPOs, and it only offers 3 plans (Preventative, 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.
In 6th place for PPO Limits, Aetna scored 2.8/10 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, tied for 3rd best with Humana 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 4th place in this metric with 5.6/10 points. Premiums from this brand start at $19, 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 preventative and as low as 20% for basic and 50% for major services. Though not exceptional in any price submetric, Aetna’s overall price structure is reasonable and predictable.
In Insurance Alternatives, Aetna shines with a perfect 10/10. Aetna’s success in this category comes from its combination of appealing choices and low costs. Aetna’s has two dental discount plans, called Vital Savings and Dental Plus RX. These plans are available for purchase on a monthly or a yearly basis, with a significant discount to those who pay annually. In a year, the total cost is $96 if you pay month to month at $8, but if you pay annually you’ll only be charged $75. Essentially, this works out to about 2.5 months of free coverage. 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.
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 3.3/5 stars overall, ranking in 5th place. This brand’s strengths showed up well in three different metrics: Plan Variety (3rd best), Plan Limits (2nd best), and Insurance Alternatives (2nd best). With high starting costs, complex coverage rules, and some mediocre customer ratings, Renaissance ranked 8th in PPO Costs and 6th in Company Reputation and Reliability.
Renaissance scored 2.8/10, 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 1700 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 7/10 points and ranked in 3rd place for Plan Variety. While Renaissance only offers one plan type, PPOs, it has 5 different PPOs to choose from (tying with MetLife and Humana for 2nd highest number of plans). Three of Renaissance’s 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 8.4/10 points Renaissance ranked in 2nd place behind Guardian. 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 0/10 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 preventative 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 $28, or $13+ more than the lowest premium from Surebridge. Deductibles for Renaissance are a reasonable $50.
Renaissance’s dental discount plan is a competitive option that ranks in second place with 8/10 points. This plan is referred to as the Healthy Savings Card and is administered by the third-party company Carington. Dental discounts range from 20%-50% for most services. Costing $96 per year, this plan is tied in costs with Cigna and Humana’s 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.
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.
Scoring 2.9/5 overall, Cigna ranked in 6th place for its dental plans. As a very well-established company in the industry, Cigna achieved 2nd place for Company Reputation and Reliability. This company had a reasonably strong showing in PPO Limitations and Insurance Alternatives, but it faltered in PPO Costs and especially in Plan Variety, where it came in last.
Cigna ranked in second place for Reputation and Reliability, scoring 8.2/10 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 753/1000, the 3rd best score among competitors that we reviewed. Cigna had 132 ratings on Google with an overall rating of 4/5 stars- 2nd best, after Guardian.
Cigna’s plan variety is quite limited, so this company ranked in last place with 0/10 points. Cigna offers just PPOand has 4 plan options, total, as does competitor Guardian. 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 4.2/10 points, Cigna ranked in 5th 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 in 7th place with 1.4/10 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 $19, though we did find that in some cases they can be as low as $14. 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 preventative across the board and can pay as low as 20% for basic and 50% for major services, depending on the plan.
Cigna scored 4/10 points for Insurance Alternatives, ranking in 4th place. Its “Dental Savings Program” excludes an unusually large number of states, including the following: Alaska, California, Idaho, Iowa, Montana, North Dakota, Oklahoma, Rhode Island, South Dakota, Utah, Vermont, Washington, and Wyoming. 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” or “senior” versions that have expanded benefits on everything from prescriptions to recreational activities. Cigna is the only company with three options. The least expensive plan is available for $96 per year, in line with the costs of Humana and Renaissance’s plans.
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. Note 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 7th place overall, Guardian scored 2.8/5 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 in last or second to last place for all other metrics.
With 10/10 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 238 on the Fortune 500 list. This company has a respectable rating of 730/1,000 from the JD Powers survey, and it has the best Google profile rating of 4.2/5 stars (based on 35 posted ratings).
Guardian scored 8.4/10 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 Illinois, Florida, New York, and Texas. Between PPOs and the HMO, Guardian offers just 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 unusually low annual maximums. This brand’s best maximum for the first year of coverage is $1,000, half that of the leading company, MetLife. Its loyalty maximum is similarly 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. Getting a waiver for those waiting periods is very difficult. The only possible path to a waiver is if you are transitioning from a group Guardian plan to an individual Guardian plan.
Guardian comes in just ahead of Cigna and Renaissance in 6th place, scoring 2.8/10 points. This company’s lowest sample quote was identical to Surebridge’s at $25, high when compared to similar plans that start around $15 elsewhere. Patients face standard costs for preventative (owing 0%) and major services (paying as low as 50%), but they will need to pay at least 30% for basic services. At most other companies, the patients can pay as low as 20% for the same service category. Guardian’s deductible is $50.
Along with Surebridge and IAIC, Guardian earned 0/10 points and ranked in last place in this category. Guardian does not currently offer an alternative to traditional dental insurance, so seniors looking for a low-cost dental discount plan will need to look elsewhere.
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 4 states.
Independence American Insurance Company, also called IAIC, scored 2.5/5 points for 8th place overall. This company offers decent Plan Variety and PPO Costs, ranking in 4th and 5th place in those metrics. With no dental discount plans, IAIC came in at last place for Insurance Alternatives along with Guardian and Surebridge. In other metrics, IAIC ranked in 7th place (second to last).
With 1.4/10 points, IAIC narrowly beats Surebridge for 7th place. Although it’s about 47 years old, this company is still far less experienced in the insurance industry than the majority of its competitors. It also shares the lowest rating of A- from AM Best along with Surebridge and Humana. As far as other measures of reputation go, IAIC has a low profile online. It isn’t profitable enough to rank on the Fortune 500 list, it doesn’t have any reviews on its Google profile, and it wasn’t included in the latest JD Powers survey. With such little customer satisfaction data available, it’s difficult to know how happy the average IAIC customer is.
For Plan Variety, IAIC has a decent score of 5.6/10, ranking in 4th place. IAIC offers both indemnity and PPO plans. It has 9 plans total, the highest number among competitors. Although there is a great variety available, discerning the differences between plans can be exceedingly difficult. You may wish to have an agent walk you through the nuances. With no loyalty plan and no benefit bundling option on its own website, Surebridge lagged a bit behind leading companies in those submetrics. IAIC plans on broker sites are sometimes offered with bundling options.
IAIC scored 1.4/10 points, ranking in 7th place. Its annual maximum for the first year of coverage is quite good at $1,500- the 2nd highest along with Surebridge and Cigna. However, since IAIC has no loyalty plan, it did not score any points for a loyalty maximum. This brand’s waiting periods are the typical 6 months for basic services and 12 months for major ones, but absolutely no waiting period waivers are available.
With 4.2 points, IAIC came in at 5th place, beating Guardian and Renaissance in this metric. IAIC and Guardian actually have an identical sample quote of $25, but the fact that some Guardian plans have less coverage for basic coinsurance meant that IAIC has a lead in costs. IAIC’s lowest quote was the 2nd highest of reviewed companies- only Renaissance had a higher starting cost of $28. With IAIAC, patients pay 0% for preventative services and as low as 20% for basic services, and 50% for major services. On all plans, the deductible is $50.
IAIC scored 0/10 for Insurance Alternatives since it offers no dental discount plans. This low score makes IAIC tie for last place along with Guardian and Surebrige. If looking at insurance plans on the IAIC website, seniors should note that they will see a form of discount plans advertised alongside the dental insurance. Those discount plans are not applicable to dental care.
IAIC plans are some of the easiest plans to find on broker websites where they are popular low-cost options. In some cases, broker sites have speciality IAIC plans that are not available on the main IAIC website. If you choose to shop directly on the IAIC website, you will notice that there is very little plan information provided on the main dental insurance page. Once you start using the location-based quote tool, you will be able to view more details. The IAIC quote tool does not ask for contact information, but it does ask about tobacco use, which is somewhat unusual.
It can be hard to have confidence in a company that’s very new, that’s struggling financially, or that’s not well-spoken of by other customers. We looked at a variety of data points in order to assess Company Reputation and Reliability, and this metric accounted for 20% of each brand’s overall score.
Accounting for 10% of each company score, the Plan Variety metric explores how much choice is available to consumers. Though this article as a whole emphasizes PPO plans, this metric focuses on which companies have something beyond a typical PPO to offer.
All PPOs place limits on coverage, but some are more restrictive than others. Since differences in coverage limits can dramatically impact patient costs, this metric was 30% of each company’s overall score.
*Note: The information for these submetrics applies to most states, but some states impose special restrictions on companies that can make waiting periods even shorter or non-existent. Check to see if your state has special insurance regulations.
The cost of a plan can be measured both by its up-front costs like premiums and by the amount of cost-sharing that a patient will need to cover within the plan when getting care. In this metric, we also explored the ease with which seniors can get a quote. This metric accounted for 30% of overall points.
*Note: When asked for personal information from quote tools, we used the following demographic details: female, age 65, non-smoking, living in Tallahassee, FL, seeking coverage for one adult with no spouse or dependents. Using the same information across companies generated comparable answers.
Not everyone wants traditional dental insurance. We looked at how many companies offered dental discount plans, a low-cost alternative to insurance that can help people save money. This metric made up 10% of the overall scores.
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.
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.
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 preventative, 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 preventative care.
Now imagine that the plan covers twice a year preventative visits that together are worth $300. If you only end up needing preventative 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.
For the same hypothetical plan above, if you use more than preventative 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 preventative 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%) _________________________ =$960 total costs to you||$300 for preventive services (100%) $200 for its share of basic services (80%) $500 for its share of major services (50%) __________________________ = $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.
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 preventative 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.
PPOs and indemnity plans are often available in preventative-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 preventative visits provided, you may save $100-$200 dollars 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. Preventative 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.
These plans, which are structured completely differently from PPOs, often cost $8-$12 dollars 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.
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.
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.
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.
|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.
No, your premiums will likely not remain the same year after year. Companies have the right to change their premiums, as well as a variety of other fees, network sizes, and more, within reason. Year to year, cost changes should be small, though they’ll add up. Generally, if a dental insurance company is going to raise its costs, it will have to notify you in writing. The state you live in will likely require that notification be sent to you a minimum of a certain number of days, perhaps 30 or 60, prior to the change taking effect. Ask companies about their price change policies when shopping.
Dental PPOs usually indicate that they will pay a specific percentage of each category of care. For full coverage plans, “100/80/50” coverage is common. The plan covers 100% of preventative, 80% of basic, and 50% of major. Another way to express this is to say the patient pays 0/20/50. Understanding the basics of service categories and percentages is a good place to start with understanding plans, but keep in mind that companies often have a list of fine print exclusions, and most plans also have a yearly coverage maximum plus waiting periods.
No, Medicare will probably not cover your dental costs. According to Medicare’s own website, seniors on Medicare pay 100% of their own dental costs most of the time. Very limited exceptions may be made for severe dental emergencies that require surgery in a hospital setting. Although it’s disappointing that traditional Medicare doesn’t offer help, those who have Medicare Advantage (MA) plans may have options. MA plans offer Medicare benefits through a private company. In some cases, the private insurance company chooses to provide extra services, including dental cleanings. If you have an MA plan, check for a dental component.
It depends. Medicaid programs will usually not help adults with anything other than emergency dental care. Medicaid does not require that states offer adult dental benefits. However, the Medicaid website does indicate that “less than half” of all states choose to provide comprehensive care to adults with the greatest financial need. Read more about general Medicaid eligibility here or explore your state’s online resources if you want to look into the possibility of Medicaid helping you with your dental needs.
Yes, veterans can get dental care through Veteran’s Affairs, which provided dental services to 580,000 veterans in 2019. In some cases, comprehensive care may be available at a low cost to the veteran. Qualifying for benefits from the VA can be difficult, as simply having served in a branch of the military is not enough. Read more about qualifying for dental benefits to see if you can get help from the VA.
Balance billing occurs when the cost that a dental office wants to charge (the UC) is higher than the maximum amount that the insurance company considers reasonable for that service (the UCR). Below you can see an illustration of how this dilemma may play out for a patient if balance billing is allowed by the plan.
The UC is $130, but the UCR is only $100. The dental plan stipulates that the insurance company always pays 80% of the URC for this service, and the patient pays the last 20% (coinsurance). Therefore, the insurer pays the dental office $80. The patient must pay the remaining $20 of the URC, plus the difference between the dental office’s UC charge and the URC.
$130 UC – $100 URC = $30 still owed the dental office.
The leftover amount is billed to the patient, and this practice is called balance billing. In this example, that means that the patient’s total financial liability = $20 coinsurance on the URC + $30 for the balance bill =$50 total.