The Need-To-Knows Of Idaho Dental Insurance

As an Idahoan, dental coverage is a beneficial and usually inexpensive additional insurance policy. It’s not required, but it is a wise investment in your health and finances.

Studies show dental coverage makes you more likely to get semi-annual cleanings and exams. YAs a result, you’ll take care of minor problems before they become big, and your oral health will improve overall. As a bonus, your insurance likely covers most of these minor procedures, so you’ll have fewer out-of-pocket expenses.

Still, many people have questions about dental insurance and whether it’s the right choice for their situation. You want answers whether you’re wondering about the cost, how to get insurance if you’re self-employed, and if the benefits are worth the price. We have them in this need-to-know guide about dental insurance-related in Idaho.

​​​​​​Why Is Dental Insurance Necessary?

Dental insurance is optional but often so affordable that many people have a policy. Unfortunately, they don’t always understand what’s covered, so they don’t take full advantage of their investment.

Uninsured? Discover affordable Dental care for adults without insurance? You deserve affordable options.

The purpose of the coverage isn’t to pay for every potential dental situation; it’s to encourage you to get preventative care to reduce the need for pricey fixes — and to offset the expense if those things happen.

What Most Dental Policies Cover

Most insurers focus on free or low-cost preventive care to meet this original intent.

Research shows that you’re less likely to develop major dental problems when you visit the dentist regularly.

You’ll avoid chronic gum disease and tooth decay with regular cleanings, exams, and following the dentist’s recommendations. So, it’s in the insurer’s best interest to provide you with coverage that makes this possible.

In general, a dental policy includes the following:

• Cleanings and exams — Coverage for preventive services and diagnostic screenings at most or all of the cost
• Fillings, root canals, tooth extractions, root planings — Basic procedures and other in-office treatments at least 50% of the cost
• Dentures, crowns, implants, and bridges — Partial coverage for major procedures

Before the insurance pays, you’ll likely be responsible for a deductible. While the deductible usually doesn’t apply to preventive or diagnostic services, you may have a copay or coinsurance.

What’s Not Covered

Every insurer’s terms differ, but dental insurance generally does not cover some services.

Orthodontic treatment coverage varies, with some plans excluding it outright and others allowing special procedures or limited payments. Cosmetic procedures, such as teeth whitening and veneers, are typically not covered under dental policies.

Another common exclusion is anything considered pre-existing. So, for instance, if you have any teeth that were missing before your policy, any treatment for problems resulting from those absent teeth might not be covered.

Terms To Know

The details of your dental policy are often hidden in confusing insurance terminology.

When you understand the terms, you know whether you’re getting the right coverage for your needs and plans.

Here are some frequently-used terms as you shop for dental insurance.

Copays And Coinsurance

Often used interchangeably, these terms are not the same thing.

If you have a copay, it’s a set amount that you pay every time you see the dentist for a particular service. Preventive and primary care likely have one copay, while specialist treatment likely — but not always — has a higher amount.

On the other hand, coinsurance rates vary based on the allowed amount for the services you received during your visit.

For example, let’s say you have a 20% coinsurance, and the dentist’s office billed your insurance $125. However, the insurance company allowed $100, so the dentist has to write off the $25 that was not authorized ($125-$100=$25).

Your coinsurance is 20% of the allowed $100 or $20 ($100 x 20%=$20). The insurance pays the rest of the visit at 80%.

The complication of not knowing what the insurance will allow can make it hard for the dentist’s office to charge you exactly the right coinsurance. Watch your EOBs (explanation of benefits) when you get them in the mail to ensure you’re paying the right amount.

Waiting Period

In some insurance policy types, like dental and life, it’s part of the standard operating procedures to have a waiting period before the policy becomes active.

A waiting period is a set time frame for paying your premiums, but the insurance won’t cover specific treatments. It’s the insurer’s way of protecting itself from people who take out coverage for one major procedure, then cancel their insurance after they no longer need it.

Annual Maximum

An annual maximum is the most the insurance plan will cover for all dental treatment for 12 months.

This max isn’t always very high. Sometimes, it’s as little as $1,500 or $2,000.

You’ll need to check that amount and then compare it to your plans for dental insurance. If you want a root canal or a complex procedure, your insurance isn’t going to pay more than the annual max towards it. You’ll still be responsible for the rest of the cost.

In- And Out-Of-Network Providers

Your insurance probably has a preferred network of providers they want you to see. These are the dentists willing to take a discounted rate in exchange for the ability to accept patients with that insurance coverage.

Some insurers only allow you to get treatment from dentists in their network. Others will pay for out-of-network therapy at a lower rate. Still, other policies, like indemnity plans, allow you to go to any dentist you want to see.

If you have a preferred dentist, ensure they’re in the network of your intended insurance or that the coverage gives you the freedom to choose.

What Types Of Dental Coverage Are Available In Idaho? Idaho Dental Insurance

When hunting for the ideal dental policy in Idaho, you can choose from many options based on your work and home situations.

From company-sponsored to government-regulated, there’s a dental plan for you.

We’ll break them down here, so you can pinpoint your next steps.

Employer-Sponsored

Depending on the company’s size, employers may be required by law under the Affordable Care Act to offer health insurance to their staff. Dental service coverage is always optional.

If your employer does choose to provide dental insurance for you, you won’t have much choice in the coverage. Additionally, these comprehensive group policies typically don’t have waiting periods and rarely have pre-existing condition clauses.

Private

Even if your employer doesn’t offer affordable dental insurance, you can get it through a private plan, such as Blue Cross of Idaho and Delta Dental, or a Medicare Advantage plan.

Monthly premiums for this coverage are often inexpensive, and you have more say in your coverage.

Maybe you’re only looking for preventative care and checkups and don’t mind paying $15-20/month for dental health coverage. You know you’ll use it, and it’s cheaper than paying out of pocket two or three times a year for cleanings, exams, and x-rays, plus the occasional filling. So there’s a plan for that.

The more coverage you want, the higher the monthly cost will be. Remember to watch out for that annual maximum!

Marketplace — Your Health Idaho

In between private and employer-sponsored is the Your Health Idaho Marketplace.

If you qualify for healthcare insurance through this program, you’ll have the opportunity to tack on a dental policy to your coverage for a little more per month.

Self-Employed

Gig workers comprise a massive part of the economy and now have a particular insurance sector.

If you fall into this category, platforms like Selfgood are ready to help you save money on your dental and health plan. Selfgood partners with the Alliance of Gig Workers, so you get largescale discounts and rates from a reputable insurance company (Aetna) on an individual level.

Read more: How To Get Low-Cost Dental Care When You’re Self-Employed

Medicaid

MCNA Dental is the Medicaid dental plan for Idaho under the Idaho Smiles program. If you qualify for this coverage, it pays for you and your family to get preventive and diagnostic treatment. MCNA Dental also covers certain therapeutic services for adults and children.

What Is The Best Idaho Dental Insurance? Idaho Dental Insurance

Now that you know in which direction to go for a policy, the next question is how to find the best plan for you and your family.

Monthly premiums are only part of the factors to consider. If you pay a little more for better coverage, the out-of-pocket expense is less overall.

How To Compare Plans – Idaho Dental Insurance

As you decide which plan to choose, look at the monthly premium last. But first, check out the benefits and coverage.

A good plan works on something like the 100/80/50 tier scale:

• Preventive coverage and diagnostics are paid at 100%.
• Fillings and other more intensive treatments are covered at 80%.
• Primary services are paid at 50%.

Yours doesn’t have to follow this tier, but it’s a good rule of thumb.

Next, check to see if your preferred dentist or any nearby offices are in the insurer’s network. You probably won’t use your insurance much if you have to drive two hours for your appointment.

Then total your out-of-pocket expenses, including the deductibles, copays, and projected coinsurance. Finally, add the monthly premium x 12 months to that total and see if you’re comfortable with what you’ll be paying for reasonable dental care.

What Other Supplemental Plans Should I Have?

You want the easiest route to the best insurance if you’re self-employed. This might not mean a full-on insurance policy. You could enjoy an indemnity plan instead or a supplemental plan to fill in the gaps in your primary insurance.

Indemnity Policies

Many gig workers use indemnity insurance as their primary health plan. Like the Aetna plans Selfgood provides its members, indemnity care gives you the power to choose any medical provider you want to visit.

You pay the doctor, then submit the claim to the insurer. After the deductible is met, they reimburse you for your expenses minus your portion.

An indemnity plan is one of the most accessible types of insurance.

You don’t need to wait for referrals or pre-approval to visit a doctor. But most of these plans require that you pay the bill and then submit the claim, so there’s an upfront out-of-pocket expense.

Dental And Vision Discount Plans

Because of the problem of the annual maximum in many dental and vision policies, some people prefer discount plans instead or use them in tandem.

Also called savings plans, these memberships (not insurance) entitle you to a discount on approved dental treatments.

You don’t have to fill out paperwork or submit claims. Instead, you go to the providers in-network with your savings plan and benefit from cheaper rates.

Let’s look at Selfgood’s dental savings plan, powered by Aetna. As a member, you can save 15-50% per visit on your services at more than 262,000 dental providers nationwide, including many in Boise and beyond.

Approved services include the most popular treatments: cleanings, X-rays, fillings, root canals, and crowns. You’ll also get discounted specialty care for orthodontics and periodontics, often excluded from dental insurance.

These plans have no open enrollment periods, deductibles, or waiting periods.

Instead of paying a monthly premium for coverage that might not help when you need it, consider a dental savings plan. You’ll know that whatever services you need will be discounted when you have Selfgood’s dental benefits discount program backing you up.

Read more: Supplemental Benefits For Independent Contractors, Entrepreneurs, And Freelancers.

Conclusion – Idaho Dental Insurance

As with most states, navigating dental insurance in Idaho can be complicated. Your route will depend on whether your employer is covering your policy, you’re aiming for private coverage, or you qualify for government-sponsored help.

Once you understand the nuances of a dental policy and why it’s essential, you’ll want to have something to buffer your out-of-pocket costs.

Whether you opt for an insurance policy or a savings plan for your dental procedures, your oral health and overall wellness will benefit from your investment.