How do you choose between employer, Marketplace and individual dental insurance?

Staring at three different types of dental insurance and not sure which one is actually right for you? Employer, Marketplace and individual plans each work differently, and the right fit depends on more than the monthly premium. Look at the total yearly cost, network, deductible, waiting periods and coverage for the care you may actually need. 

What you will learn in this article: 

• Employer plans can be convenient, but your choices depend on what your job offers. 

• Marketplace dental coverage may be part of a health plan or offered separately. 

• Individual plans let you compare options outside an employer’s plan. 

• The total cost, network, waiting periods and coverage limits all matter when choosing. 

If you are unsure which plan fits your care needs, schedule an appointment with an Aspen Dental provider. Your care team can identify care you may need and provide an estimate. Your insurer can confirm your exact benefits. 

What should you know about your own dental needs first? 

Start with your mouth, not the plan. A plan helps only if it covers care you are likely to use. 

Think about routine exams, fillings, gum care, dentures and any treatment already recommended. If you are not sure, ask your dental provider what may need attention this year and what can safely wait. 

Take that list to each plan. Check whether each service is covered, how often it is covered and what share of the cost you would pay. 

Who does each type of plan fit? 

Each option may work better for a different situation. Here is who may benefit most from each type of dental plan. 

Choosing an employer plan? 

An employer plan may fit if your job offers dental coverage, especially if your employer pays part of the premium. Your employer chooses the plan or a short list of plans, so your options may be limited. 

Ask when coverage starts, whether the plan has waiting periods and what happens to your coverage if you leave your job. 

Choosing a Marketplace plan? 

A Marketplace plan may fit if you are buying health coverage through HealthCare.gov. Dental benefits may be included in a Marketplace health plan or offered through a separate dental plan. HealthCare.gov notes that you cannot buy a separate Marketplace dental plan unless you are buying a health plan at the same time. Separate adult dental plans may also have waiting periods.¹ 

Check whether dental coverage is included with the health plan or requires a separate premium. Compare the costs, deductible, waiting periods and services covered. 

Choosing a private or individual plan? 

An individual plan is one you buy on your own rather than through an employer. It may fit if you are self-employed, your job does not offer coverage or you want to compare options outside an employer’s plan. 

The American Dental Association describes several plan designs, including preferred provider organizations (PPOs), dental health maintenance organizations (DHMOs), indemnity plans and discount plans. Discount plans are not insurance. They give members access to lower rates from participating dental providers, but members pay the dental provider for their care.² 

What if you have Medicare or Medicaid? 

The National Institute of Dental and Craniofacial Research explains that Medicare does not cover dentures or most routine dental care, including checkups, cleanings and fillings. It generally covers dental services only when they are connected to certain medical conditions or treatments.³ 

Medicaid coverage differs by state. Children enrolled in Medicaid must receive dental benefits, while states choose whether to provide dental coverage for adults. Most states offer only limited adult dental services.³ 

Check your state’s Medicaid rules or your Medicare coverage before counting on either program to pay for dental care. 

What happens if you wait to choose? 

Taking time to compare plans is reasonable but check the timing before you delay signing up. Marketplace enrollment follows set periods, and separate Marketplace dental plans may make adults wait before some services are covered.¹ 

You can still ask a dental provider which treatment needs attention now and which can safely wait. If you need care before coverage begins, ask the dental office for an estimate and available payment options. 

Do not let a coverage question keep you from getting care. Reach out to your dental provider to review your dental needs and discuss ways to manage the cost. 

How do you choose between employer, Marketplace and individual dental insurance? FAQs 

Still have questions about choosing dental insurance? These answers cover a few common concerns.

Can I have more than one type of plan? 

You may be able to. Ask each plan how it handles a claim when another plan is also in place. The plans may divide the covered costs differently. 

When can I sign up? 

Enrollment timing depends on the plan. Employer, Marketplace and individual plans may have different sign-up periods. Ask the employer or insurance company directly for the dates that apply to you. 

What does in-network mean, and why does it matter? 

An in-network dental provider has an agreement with your plan. Your cost at an in-network office may differ from what you would pay outside the network. Before enrolling, ask the plan whether your dental provider is in its network. Then confirm that information with the dental office. 

What is a waiting period? 

A waiting period is the amount of time you must be enrolled before the plan begins paying for certain services. Not every plan has one, and the length may differ by service. Ask which treatments have a waiting period and when those benefits begin. 

Sources 

¹ U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, HealthCare.gov: “Dental Coverage in the Health Insurance Marketplace®.” https://www.healthcare.gov/coverage/dental-coverage/ 

² American Dental Association: “An Introduction to Dental Benefits.” https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/dental-insurance/intro-to-dental-benefits.pdf 

³ National Institute of Dental and Craniofacial Research: “Finding Dental Care.” https://www.nidcr.nih.gov/health-info/finding-dental-care